Apparently, our wonderful NHS, the envy of the world, is in a right old mess. So says the independent report written by the independent peer Lord Ara Darzi after his independent and strictly apolitical review of the service. It may come as a shock to readers, but according to this scrupulously independent and impartial report, the main problem appears to be ‘chronic underinvestment’ since the year 2010, despite year-on-year real term funding increases from British taxpayers for that entire period.
As with most political publications, the report is more interesting for its omissions – for example, someone clearly forgot to mention that the independent Lord Darzi was a Minister of Health in a previous Labour administration and, until 2019, he sat in the House of Lords as a Labour peer.
I doubt many voters will be deceived by this choreographed political street theatre. As with the recently discovered ‘£22 billion’ budgetary black hole, most of the public will see straight through the spin. In political terms, Labour is attempting to ‘manufacture consent’ – first described by the influential American journalist Walter Lippman in 1922. Lippman described the process by which political elites construct the version of reality they wish the public to believe, by manipulating the press. The theory is based on Lippman’s premise that the modern world is too complex for any individual to fully understand. Hence selective presentation and interpretation of facts can be carefully crafted to justify predetermined policy choices by those capable of controlling information flow.
There is absolutely nothing in the 163 pages of Darzi’s report which is in any way surprising or novel. The publication is a data dense narration of well-known problems with few attempts to explain familiar glaring paradoxes:
Why does the NHS service consistently underperform on every possible metric despite huge budgetary increases?
Why does hospital productivity continue to fall, despite a 17% increase in hospital staff?
Why can’t patients access GP appointments in a timely manner, despite there being a 6% increase in the number of General Practitioners?
What explains the appallingly bad outcomes in cancer and cardiovascular diseases compared to every other developed world healthcare system?
What explains the disparity in post pandemic recovery between the NHS and our European neighbours?
According to Ara Darzi, these failings have nothing to do with poor management. Nor can they be blamed on the ever diligent and dedicated workers. The alternative reality presented by the former Labour Health Minister, suggests the problem lies in a £37 billion shortfall in capital investment because the evil Tories starved our precious NHS of taxpayer largesse. In Darzi world, as with the wider NHS, failures are always someone else’s fault.
Yet once the media froth has subsided on their futile attempt to blame all the woes of the NHS on the previous administration, Starmer’s ship of fools are left with a serious problem – the ball is now firmly in their court. As the self-proclaimed party of the NHS, voters will soon expect Labour to deliver tangible improvements in both performance and productivity – to quote Michel Barnier “the clock is ticking…”
Thus far, Labour have been long on generalities and short on specifics. Wes Streeting piously chants the word “reform” more frequently than Starmer refers to his father’s occupation (apparently, he was a toolmaker). To date, I’ve not seen a definition of ‘reform’ other than vague commentary about benefits of digitalisation, consistent with the prevailing delusion that ‘machine learning’ will save us from public sector profligacy and inefficiency. Irrespective of what the Health Secretary means by ‘reform’, there is a major obstacle to whatever plan he is hatching. I’m confident that the NHS workforce and their Healthcare Unions define ‘reform’ as consecutive above inflation pay rises, more working from home, part time contracts and enhanced pension entitlements.
And here lies the essential problem with the NHS. Despite the sanctimonious claptrap and aggressive hostility to criticism, the primary concern of the NHS is the welfare of its staff, not its customers. In economic terms, this is a variation of the ‘principal-agent problem’ –a conflict in priorities between the owner of an asset (the taxpaying public) and the person to whom control of the asset has been delegated (the NHS management and workforce). Taxpayers have no direct control and virtually no leverage over the professionals in the NHS. With a socialist government beholden to their union paymasters, this problem is set to worsen.
For example, when the incoming Labour Government immediately agreed a 22% pay rise for junior doctors, the Chairman of the BMA committee assured his followers that they could be back on strike to demand yet more money within a year.
The BMA General Practitioners Committee has advised its members on a range of “work to rule” actions designed to bring the NHS to “a standstill” and is threatening further industrial action in pursuit of an 11% annual pay increment. These two professional groups will not be the only ones extorting money with menaces from Starmer’s compliant administration.
The solution to the principal-agent problem is to directly align the interests of the manager/provider with those of the owner – in other words construct an incentive system which rewards the productive and penalises the idle. This would be my definition of ‘reform’ – a move towards a continental style mixed health economy, social insurance-based system which pays doctors per unit of work done, rather than our current upwards-only salary scale under which the inefficient are paid the same as the industrious.
Darzi, however, sees things differently: “Nothing that I have found draws into question the principles of a health service that is taxpayer funded, free at the point of use.” If he really is that myopic, the noble Lord needs to visit Specsavers. Of course, Darzi is neither short-sighted, nor independent. Stripping back the waffle and verbal padding, the single big idea in his 163 pages is the dissemination of digitalisation:
There must be a major tilt towards technology to unlock productivity. In particular, the hundreds of thousands of NHS staff working outside hospitals urgently need the benefits of digital systems. There is enormous potential in AI to transform care and for life sciences breakthroughs to create new treatments.
If I were being cynical, I might consider a state-run healthcare system with an annual budget of £165 billion a major business opportunity for large technology companies. Highly lucrative multi-year contracts backed by the British taxpayer would be a tasty prize, to say nothing of the massive amount of health-related data to be exploited.
A sceptical mind could imagine how such companies might go about lobbying persons of influence with a new government confronting an urgent political imperative.
Fortunately, we have an independent report expertly crafted by an independent expert to ensure that could never happen.
Consent manufactured.
The author, the Daily Sceptic’s in-house doctor, is a former NHS consultant, now retired.
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