So. According to all the media reports, and the scaremongering from professional bodies, the NHS is in crisis and falling apart because it is significantly under-funded and a political football. It is barely “muddling by” [1,2,3].
Well maybe.
It cannot be denied that the NHS is in crisis. It is badly organised and badly managed. And yes it is a political football.
I’ve written about this before [4,5] and I make no apology for doing so again.
It cannot be denied that some sectors of the NHS are woefully under-funded. This is especially true of GP services where funding has fallen from a high of 11% of NHS budget in 2006 to around 8.3% today against a background of significant increases in the number of consultations and demands from politicians [6].
However overall I cannot believe that the NHS is under-funded. It seems to me the NHS has shed-loads of money to do everything you and I could reasonably want it to do. But that money is badly used, in large part because of the appalling level of wastage.

The NHS employs way more managers and administrators than it needs. That in itself is a huge waste of resources. Just take a look next time you visit a hospital at how many staff are wandering about apparently aimlessly. What do they do? Is it useful? How many are doing nothing but moving pieces of paper from A to B? In this day and age moving pieces of paper around by hand is an inexcusable waste. Do it electronically! Use email, or on-line documents, or database systems.
Yes, to get the NHS using pervasive electronic communication is going to take time, and will need an up-front investment. It will also need the Civil Service and government not to cut corners on cost by being constrained to choose the cheapest bidder, to understand how to manage a big IT project (like don’t keep changing the project scope) and to listen to advice from their trusted suppliers.
The NHS also has far too many managers. Their lives seem to be predicated on bullying staff and chasing meaningless government targets. If we could get rid of the pointless targets and teach the managers how to manage people the NHS would need far fewer of them. In doing this it will take the NHS quite a long way towards trusting and empowering its employees. Trust them to do their job. Trust them with the empowerment to do it efficiently. Empower them to change things sensibly if they can see a better way. In other words, act like a good private company.
Somewhere else the NHS wastes money is in the sheer waste of supplies. One hears stories of hospitals where Ward A needs supply Y but can’t buy it because there’s no money; yet Ward B has a cupboard full of the same supply but has to throw it away because it has gone out of date. In one instance I know of where this happened, and it was pointed out to the top brass by a junior nurse, just changing the procurement policy saved the hospital several million pounds in the first year. Practices like this are not uncommon.
And let’s not talk about hospital food. If patients were fed properly, not only would there be a lot less food waste but the patients might actually get better quicker so they could be discharged sooner.
This is all well and good but I fear it will never happen. For a start politicians, almost by definition, have to keep meddling. Not only is it ideological but it is the only thing they can do to try to show they are doing something.
The other reason it will never happen is that there is no-one at the top of the NHS who has the ability to grasp the whole organisation and energise it. That is not the Civil Service way. But without this there will be no change. The NHS needs someone highly skilled, robust, no-nonsense and bloody-minded to head it up. Someone who will energise the employees, from top to bottom. Who will empower from the top and support empowerment from below. Who will give his or her henchmen a job to do and expect them to get it done — or get out. And most importantly someone who will tell the politicians to butt-out and stay out.
Names like Richard Branson, Alan Sugar and Digby Jones come to mind. You may not like them, but they are the type of people who are needed. Badly needed.
Without someone like this, and without government getting a proper, business-like grip, the NHS is indeed going to go nowhere except, as predicted, down the tubes. And that is something the country cannot afford!
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References:
[1] Observer; 28 June 2014
[2] Daily Telegraph; 18 June 2014
[3] Independent; 29 June 2014
[4] https://zenmischief.com/2014/02/transforming-the-nhs/
[5] https://zenmischief.com/2012/08/reforming-the-nhs/
[6] Royal College of General Practitioners; 27 June 2014