The Bureaucrats Destroying Our Healthcare System

Plenary: Stephen Dorrell MP
Mr Nanny State: Stephen Dorrell – image by NHS Confederation via Flickr

Health Secretary Andrew Lansley has been trying to implement an NHS under control of GPs. The idea is that GPs band together into “GP Consortia”, which will commission healthcare services for their patients.

The Consortia therefore take the place of the old Primary Care Trusts – the difference being that they are run by GPs rather than bureaucrats.

So far so good.

Except that it seems the bureaucrats have got their teeth well into this.

The House of Commons Health Committee have been banging on again about how the government needs to consider tougher rules on alcohol marketing.

The “chair” of the Committee, and former Health Secretary, Conservative Stephen Dorrell, said:

We don’t think the industry has a sufficiently well-developed sense of what it takes to trade responsibly.

Some of us are wondering whether MPs have a sufficiently well-developed sense of what it takes to represent us responsibly, but let that pass.

Mr Dorrell’s committee has produced a report. They want a “crackdown”.

The report called on Public Health England, a new body within the Department of Health, to look at the regulation system used in France.

Loi Evin was introduced in 1991 and bans alcohol advertising targeted at young people and being aired in cinemas as well as stopping the sponsorship of cultural or sporting events.

Yet more interference and messing around with people’s lives from the great and the good, then. Men like Mr Dorrell, who understands so well how we ought to be living our lives.

But “Public Health England”, eh? Who are they?

Chief Executive Designate Duncan Selbie took up his role this week and has set out his ambition for Public Health England to begin the conversation about how the agency will work, the ambitions it will have and the style it will adopt.

Sounds like it’s not clear what the body is for then…but we definitely need it….

‘The Secretary of State for Health has made clear his expectation that Public Health England will provide strategic leadership and vision for the protection and improvement of the nation’s health.

‘Through the application of research, knowledge and skills we will lead nationally and enable locally a transformation in the health expectations and, in time, outcomes of all people in England regardless of where they live and the circumstance of their birth.’

Further information, including modules of the Public Health England People Transition Policy, will be published in the next few weeks.

And so on through reams of meaningless bureaucratic twaddle.

The whole ghastly mess is helpfully set out in this graphic.

It’s nearly as bad as Obamacare. Make no mistake, this is the last chance to reform the NHS, as I’ve said before on this blog. If these reforms fail, the service will collapse.

And fail they will. The NHS is just re-arranging the deckchairs on their Titanic.

I am now more convinced than ever that the National(ised) Health Service can never work. Its whole philosophy and culture is poisonous. The people who run it just cannot conceive of anything being run without a centralised strategy. They don’t understand markets; they don’t understand decentralised decision-making; they absolutely don’t understand, or don’t want to understand, the concept of an NHS that answers to patients as opposed to answering to themselves.

And perish the thought that they should ever just let people get on with their lives in their own way without interference.

They are arrogant, pompous and out of touch. And they are grabbing billions of our money every year. A plague on all of them.

The Government Fines Itself £325,000


A hospital trust has been fined £325,000 for losing confidential patient information. The hospital concerned is appealing, but it’s a scandal.

Who is being punished here? If that hospital loses £325,000 then that money can only in the end come out of the hospital’s budget – unless the government simply gives them extra budget to pay the fine.

This goes to the heart of the problem with State-run industries like the NHS. What happens when those industries don’t deliver?

In the normal private sector, companies that do things like this lose customers, and may ultimately go bust.

Even where there is a private sector monopoly, as in the water industry for example, the outputs of the industry concerned are ensured by regulation. In theory at least, fines like this one would come out of the dividends that would otherwise be paid to the company’s owners.

But in a government monopoly like the NHS, fines are being paid, in short, by the government to itself. (The costs of the legal action, of course, aren’t paid to the government itself. They go to lawyers and have to be paid for by taxpayers.)

This is just one isolated case – but it is a reminder to us all of just how lacking in accountability is the NHS. Socialists always tell us it is accountable to the people through their elected government.

The truth is that the NHS is accountable to nobody and makes up its own rules.

Unless the NHS trusts are brought into real competition with each other, the people have no sanction when they don’t deliver.

The NHS Business Services Agency – Failing Student Nurses

We all know there has been a lot of controversy over student finance.

We’ve had the tuition fees debate, with tuition fees of £9,000 now the norm.

The government has overhauled the student support scheme. There seems to be a lot of confusion about this, but basically, you get a loan to cover the tuition fees, and a further loan that is mildy means tested to help with maintenance. Despite the confusion, those who look can find out the exact details.

If you want to go to university in September, you can find out what your financial position will be.

But what about people who want to be nurses? The normal student support arrangements do not apply for them. They have different arrangements.

How much will they get?

I wish I knew. Nobody does.

We do know they will get a £1,000 grant from the NHS. We do know they will get their tuition fees paid by the NHS. We do know they will get a maintenance loan from Student Finance. That loan is smaller than the one other students get, but again is not means tested.

They will also get a means-tested loan from the NHS. The maximums have been published, but astonishingly, the NHS has still not published the thresholds for the means testing for 2012/13.

Would be students are already in the application process for “uni”. They are advised by Student Finance to apply for their loans by 31st May.

Meanwhile the NHS says it will make application forms available in June. For students who will actually go to university in September! When the thresholds will be publshed, nobody knows.

The “NHS Business Services Agency” (sic), which pays the NHS support, is apparently still mired in processing applications for last year’s students. Shades of the early days of the Tax Credits Office.

They are expecting people to apply for nursing courses with no idea of how much financial support they will get. Would-be students can’t even look at last year’s rates and assume they will be fairly similar, because the system has changed completely.

This is no small deal. For a student studying outside London, the non-means-tested loan from Student Finance is £2,324. That non-means-tested grant from the NHS is £1,000.

And the means-tested grant will be up to £4,395. But if their parents earn a lot, it will be less. Possibly a lot less, or even zero. But the NHS hasn’t decided how much yet.

That student will get between £3,324 and £7,719. And that’s all they know.

More than half of that student’s financial support is completely unknown, and they are applying blind from a financial point of view.

Meanwhile, although they can’t tell you how much money you’ll get, and have a pathetic website with hardly any information, they do, it seems, have time to maintain a Facebook page containing repeats of the same vague answers.

What an unprofessional, sloppy, dysfunctional mess the NHS is. It seems it has no more concern for its staff, or would be staff, than it does for those unfortunate enough to be its patients.

The irony is that if it were a private sector company acting in this way, it would be taken to the cleaners.

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The NHS Jobsworths Employed to Brand Kids as Fat


is it time to ring some changes?
NHS Change 4 Life Poster - by Leo Reynolds via Flickr

Yeah. Let’s Stop Them Gobbling Our Taxes

The NHS Jobsworths have produced yet another set of scare scatistics, this time on “child obesity”.

NHS figures for the past year show 19% of children in their final year of primary school were classed as obese, compared with 18.7% the previous year.

But obesity fell to 9.4% in children going into reception, down from 9.8% the previous year.

Apart from producing a great source of copy for the media, what is the use of these statistics?

They are produced by The National Child Measurement Programme (copyright: Tony Blair 1995). This measures all schoolkids when they start primary school and again as they get to the end of primary school.

The purpose, according to their website, is:

The information collected helps your local NHS provider to plan and provide better health services for the children in your area.

In other words, they serve no purpose – unless “health services” includes putting pressure on parents to turn their kids into anorexics.

We all know that cakes and chips are bad for our kids, don’t we? And we all know that feeding our kids healthy food is a good idea. The statistics prove that … wait for it … people feed their kids cake and chips anyway.

Obviously no figures are published for the cost of all this, as NHS finances are completely opaque to the public. But the cost of this measurement programme must be quite high. The survey is after all measuring a million pupils every year. The survey – even without the pseudo “actions” that are taken as a result of it – must run into many millions of pounds of our taxes.

One can only hope that not too many children (and their parents) are made miserable by being branded “obese” when a fifth of kids are heavier than they are.

But mostly, really, the jobsworths who waste their lives running this programme just need to be told to p*** off. We don’t need their useless information, and we don’t want our taxes wasted on their salaries.

They are a great example of why the NHS is crumbling.

In case you are indeed one of those jobsworths yourself reading this, and ask whether I am embittered by myself being a victim of this 1984-style programme, the answer is that no, I have not fallen foul of it myself.

The NHS Generation

NHS Hospital Corridor
Image by Laura Mary via Flickr


The Patients’ Association has published a dossier outlining what they call “shameful attitudes” to the care of elderly patients.

Katherine Murphy, the Association’s Director, did not mince her words:

We cannot ignore the fact that some trusts are not even paying lip service to the fundamentals of care.

The issues we continue to highlight are human rights issues. They show a lack of compassion and care and a shameful attitude to treatment of the elderly.

The government, however, was brushing it all off with platitudes:

The government said it was determined to “root out poor performance”…

A programme of unannounced inspections would continue, the Department of Health added…

A spokesman for the Department of Health said: “The Patients Association is right to raise these examples and issues, and we will work with them and with the NHS to sort these problems out.”

Angela Rippon was on the Today programme this morning for the Patients’ Association, talking about the report. She specifically made the point that the issues are not confined to care of the elderly, but are widespread across the NHS. After going through the appalling neglect that was highlighted in the report, however, she went off at a tangent.

She started talking about how most nurses in the NHS are “superb” and provide “wonderful care”, and the problems are all the fault of “a few rotten apples in the barrel”.

She has completely missed the point. The problem is not a few rotten nurses, but an entirely rotten system. That system drives even good nurses to behave badly. It cripples them with red tape. It takes control away from them, and gives it to bureaucrats. It demoralises and demotivates them. They are victims of that NHS system, just as much as the patients are.

And the same goes for those overworked doctors, rushing from patient to patient with never enough time, and for the ancillary workers too, paid a pittance and held in contempt by the system because they are doing menial but vital tasks like cleaning the floor or serving dinner.

The nurses are just human beings, doing a job. The system is what is wrong, not “a few rotten apples in the barrel” that simply need to be rooted out.

The NHS is driven by top-down centralised management and that is the cause of the widespread – and they really are widespread – failings of the NHS.

As I blogged before, Andrew Lansley, the Health Secretary, is trying to push through reforms to put the service in the hands of groups of GPs, called GP Consortia. And the response of the bureaucrats? They have set up a new body to “oversee” the Consortia, headed up by the guy who is currently NHS Chief Executive. In other words, they are turning the GP Consortia into clones of the old Primary Care Trusts, and keeping an iron grip on the central control of the service.

Like so many of her generation, Ms Rippon just can’t quite grasp that the NHS is utterly broken, that its problems are inherent in the way it is set up. They cling on for dear life to that comfortable fantasy, that the NHS will always look after them, and make sure they never suffer. They see it as a great big much-loved teddy bear, a bit threadbare but always there for a hug.

It is time we grew up, and saw the NHS for what it is. Our hospitals are characterised by sloppy care, bureaucratic waste, filthy wards and demoralised staff. The care they provide is too often scandalous. People are dying – literally – because of its failings.

For decades the Left have peddled the lie that the only alternative to today’s monolithic NHS is a free market free for all, and held up the spectre of health services “like the ones in America”. And Ms Rippon’s generation have – almost to a man and woman – been suckered by that lie.

But that is what it is. A lie. Other countries do better.

I have visited a hospital in Ukraine. As you would expect with a relatively poor country that was part of the Soviet Union, there are many problems. Drugs are in short supply, for example, and corruption rife. But I’ll tell you this. That hospital was spotless. The floor, from wall to wall and in the corners as well, gleamed. The window sills were shiny. The whole building smelled strongly of disinfectant, just as NHS hospitals used to when I grew up in the 1960s. Basically, despite all the problems, the people running that hospital knew what they were doing, and had discipline and the right priorities.

By contrast, the large NHS hospital I visited frequently while my first wife was ill with cancer in 2000 was drab and run down, with grubby floors and an air of aimless chaos. Until one day I pressed the wrong button in the lift and went up to the administrative levels by mistake. Those levels were well decorated, with a nice and spotless carpet on the floor and row upon row of offices with computers on the desks. It was clear to me where the priorities of that hospital lay. OK, that was a decade ago. Have things really changed for the better since then? I doubt it.

The problems of the NHS cannot be eliminated without entirely reforming the system. Until then, the poor performance won’t be rooted out. The problems won’t be sorted out, and the unannounced inspections will achieve nothing except to tell us what we already know – that the NHS is failing.

Perhaps once the NHS Generation of Angela Rippon are gone, we can start a grown up debate about the future of Britain’s health services. Until then, people will go on suffering and dying.

This is How Bureaucrats in the NHS Prevent Change

Sir David Nicholson
Image by NHS Confederation via Flickr

Sir David Nicholson – Bureaucrat in Chief in the NHS


The BBC reports on the setting up of a new NHS Commissioning Board.

The board, which will at first operate in a shadow form, will aim to help patients “shop around” and compare GPs.

It will take on the day-to-day running of the NHS, with a staff of around 3,500 and overall responsibility for NHS care worth £80bn…

Its role includes overseeing the new clinical commissioning groups led by GPs and other clinicians who will “buy” care within the NHS, and organising the treatment of complicated conditions such as heart transplants.

3,500 staff! Now we know where all those redundant Area Health Authority employees are going.

And its Chief Executive will be Sir David Nicholson, who has been Chief Executive of the NHS in England since 2006.

Andrew Lansley’s NHS reforms are designed to decentralise, to create competition within the NHS, and to put the NHS budget in the hands of groups of GPs.

This new Commissioning Board is going to “oversee” the GP groups. In other words, it is the bureaucrats making sure they maintain central control.

What all this means is that nothing will really change in the NHS. The GP groups will be accountable to the Commissioning Board, when the whole point of Andrew Lansley’s reforms is that they should be accountable to GPs.

The bureaucrats are, as usual, waging war on the democratic decisions of the elected politicians. In the short term, they can certainly do this. In a war between Mr Lansley and the Civil Service, I wouldn’t put money on Mr Lansley’s chances of victory.

But in the longer run, this move increases the chances that the NHS will, ultimately, face collapse and dismantling. We are already seeing a great deal of anger from ordinary people at the performance and care provided by today’s NHS. The depth of support for the very existence of the NHS is much shallower now than it was 30 or 40 years ago.

Mr Lansley’s reforms were the last chance to save the NHS. If the bureaucrats like Sir David succeed in neutering them, the NHS simply does not have a future.

Those bureaucrats are playing right into the hands of the enemies of the NHS.

Our Failing Nationalised Health Service

British Railways Board
Image by gregwake via Flickr

Nationalised British Railways – Not So Different from the NHS

A new report by the Care Quality Commission on the NHS has highlighted serious failings in the care being provided to elderly patients.

The report is pretty damning, and itself calls its findings “alarming”:

[Problems] included call bells being placed out of the reach of patients, staff speaking in a condescending or dismissive way and curtains not being closed properly.

In terms of nutrition, some people who were judged to need help eating were not getting it, while interruptions meant that not all meals were being finished by patients.

The regulator also said that in too many cases patients were not able to clean their hands before meals.

The report identified three main reasons for the failures – a lack of leadership, poor attitude among staff and a lack of resources.

A lack of leadership, poor staff attitudes and a lack of resources. Those are pretty fundamental failings. Obviously the Royal College of Nursing was highlighting the lack of resources. But the Labour government provided an absolute tidal wave of additional resources for the NHS! In fact, under Labour, NHS spending more than doubled. And this government, even during its “austerity” programme, has continued giving the NHS inflation-busting increases.

If there is a lack of resources, it is because the resources being provided are being misused. If there are poor staff attitudes, it is because they are not being managed properly.

It all comes back to that first issue – “a lack of leadership”.

So what is going to be done about it?

Health Secretary Andrew Lansley said he would encourage whistle-blowers to highlight any concerns they had about the standard of hospital care for the elderly.

He said: “We expect that staff across the NHS, if they see examples of poor care they blow the whistle on that, which is precisely why we have introduced changes to the staff contract.”

Both the government and the NHS Confederation, which represents managers, said examples of poor care were “unacceptable”.

Great. Their big plan for dealing with these serious failings is to encourage people to report the issues.

What will they really do about the issues? The real, true answer is NOTHING. Because they cannot do anything. These failings are INHERENT in a health service model that involves a centrally run nationalised industry delivering the services.

It happened in every nationalised industry. From the old Gas Board through the GPO Telephones to British Rail, those same failings were evident. They are inherent in that model for service delivery.

The failings of the NHS are built into the NHS itself.

Daniel Hannan criticised the NHS in America last year, and Tory politicians including David Cameron fell over themselves to condemn what he said. But what he said was true.

The National(ised) Health Service experiment is a failure. There is a reason why no other major country runs its health services like this. No, it is not because they are all envying our amazing NHS and cannot match it. It is, in fact, because it doesn’t work.

That does not mean you cannot have tax-funded healthcare available to all, of course.

The Socialists in the Labour Party and elsewhere always pretend that is the choice. It is not. We have, for example, privatised refuse collection in most local authorities. That does not mean households have to pay the contractor to have their rubbish removed. It just means that private companies are running the service, and competing for the contract.

The NHS needs real, fundamental, serious reform. Even Andrew Lansley’s reforms do not go nearly far enough, though they are a step in the right direction.

Nationalisation is a failed 20th Century solution. And the National Health Service right now is a nationalised industry.