It’s often said that politics is showbusiness for ugly people, so it should come as no surprise that Keir Starmer loves a bit of street theatre – like robotically announcing the demise of NHS England while visiting a Reckitt Benkiser factory for example. Last week sitting down in the Oval Office, this week a stand-up gig in Hull. Are you not entertained?
Readers unfamiliar with the arcane administrative minutiae of our beloved and world beating NHS may wonder what all the fuss is about – and with good reason. To understand what’s happening, we need to take a trip in the TARDIS (Time and Relative Dimensions in Space), back 25 years to the regime of ‘Call me Tony’ and his Health Minster Alan Milburn, ably assisted by youthful SPAD Simon Stevens.
Things were different then. The management of our revered and precious NHS was centralised within the Department of Health. It was a time of centrally imposed targets for hospitals with financial penalties attached for failure. Tight media management, presentational sleight of hand and gaming of metrics. Some colleagues called it a ‘Stalinist system’. I couldn’t possibly comment.
It was a time of hope and expectation. The eminent surgeon Lord Darzi was brought in to advise the Government on improvement initiatives. Several projects were instigated all guaranteed to improve efficiency and clinical results – for example Diagnostic and Treatment centres (failed), Community Polyclinics (failed), publication of individual surgeon’s outcome measures (failed)… I could go on, but despite the general fabulousness of the glorious NHS, ungrateful patients still seemed dissatisfied and regularly berated politicians in front of TV cameras. Complaints often centred on short-termist politicians interfering with the national treasure that was the NHS.
On the change of Government in 2010, new Health Secretary Andrew Lansley had a big idea. Management of the NHS would be separated from the Department of Health. The NHS would be granted operational autonomy from government – no more political interference in day-to-day affairs. Lansley assumed that the public would then blame NHS management rather than the politicians for any shortcomings. He was wrong.
Lansley set up NHS England in 2012. He overlooked three crucial factors. The first relates to accountability. NHS apparatchiks do not have to stand for election and are effectively immune from being sacked. Politicians are not. Hence, despite NHS England presiding over the consistent inexplicable underperformance of our wunnerful NHS, the public continued to blame elected representatives rather than professional managers.
Second, Lansley forgot the ‘iron law of oligarchy’, a tenet of social science articulated by the German sociologist Robert Michel in the early 20th Century. Simply put, this concept maintains that any organisation evolves to serve the interest of its elite managing cadre rather than the interest of other stakeholders. I could not possibly comment further.
Finally, and most significantly, Lansley underestimated Simon Stevens, who took over as Chief Executive of NHS England in 2014. Stevens was probably the most talented politician of his Oxford cohort (which included Cameron, Johnson and Starmer). He expanded NHS England to 20,000 employees, centralising control of information, finance, regulation and authority across the entire network of the English Health Service. NHS Trusts were subject to tight control and supervision from NHS England in a regime some considered ‘Stalinist’. I could not possibly comment.
Simultaneously, Stevens lobbied for and obtained massive extra funding from central government – its budget currently stands at £200 billion a year. No matter what the problem was, the answer was more taxpayers cash for our chronically underfunded and victimised NHS. Inexplicably, service productivity continued to decline. Fortunately, managers at NHS England were able to retain a semblance of dignity by patronising top class hotels and hospitality on their expense allowances. Stevens was awarded a knighthood in 2020 and a peerage on his retirement from the NHS in 2021. He was succeeded as CEO of NHS England by Amanda Pritchard, a previously popular and effective CEO of Guy’s and St Thomas’s Hospital.
So, to July 2024 and the change of governing regime. The youthful and inexperienced Health Secretary Wes Streeting needed reliable advice. Alan Milburn the former Blairite incumbent seemed a natural fit for a position as the lead non-exec on the board of the Department of Health and Social Care, having pursued a prosperous career in healthcare consultancy via his personal company AM Strategy Ltd.
Streeting’s first act as Minster was to invite the eminent surgeon Lord Darzi to conduct a comprehensive review of the ‘broken’ NHS. It is a matter of record that NHS England has presided over a steady decline in NHS productivity. Despite a 17% increase in the NHS‘s workforce over three years, productivity has fallen year on year. The influential House of Commons Public Accounts Committee reported in January on the state of NHS finances, commenting: “The scale of Government’s ambitions is great, but senior officials do not seem to have ideas, or the drive, to match the level of change required, despite this being precisely the moment where such thinking is vital.” Some readers might consider that to be a political pitch roll for a pre-determined plan to abolish NHS England. I could not possibly comment.
The recent extra £20 billion generously granted from taxpayer’s funds by the former highly experienced Bank of England economist Ms Reeves is unlikely to shift the stubborn productivity dial – the money has already been absorbed by pay increases and rising inflation. Therefore, the decision has been made to bring NHS management back under the direct ‘democratic’ control of the Department of Health. Some colleagues fear the regime will be ‘Stalinist’. I could not possibly comment.
So, what can readers expect from the abolition of NHS England? Well in the short term, absolutely nothing – by that I really do mean nothing. Many of the soon to be former employees of NHS England will spend the next three months working out their notices, looking for other jobs and planning where to invest their redundancy payments – the cost of which is estimated at between £800 million and £1 billion.
In the meantime, hospital trusts will be in limbo, waiting to be told how the new regime will operate, how funding mechanisms will work and how services will be commissioned. Senior management will probably be distracted by process adjustments and recalibrating to the new reality, rather than focusing on the important task of waiting list reduction and operational efficiency. The new Integrated Care Boards (ICBs) are similarly still bedding in having been the subject of a recent review by another former Blairite Health Minister with a lucrative second career in healthcare consultancy, Dame Patricia Hewitt.
The scrapping of NHS England is all about efficiency and avoiding duplication of bureaucracy. Or so they say. Feel free to call me sceptical, but my suspicion is that many of the former employees of NHS England will soon find themselves assigned new jobs within the Department of Health or the new ICBs doing much the same as before.
We find ourselves going ‘back to the future’ on health policy even to the extent of resurrecting the same cast members from 20 years ago. Consider the set design of Starmer’s open mic slot in Hull. Prime Minister in tieless, shirt sleeve order, cuffs turned back, delivering ‘man of the people’ faux frank oratory. Curiously reminiscent of the current occupant of an anonymous looking office building on Great Portland Street – home to the ‘Institute for Global Change’? (Google it). Same band, different front man. Readers may also like to consider the counterfactual – if the evil Tories had abolished NHS England, how might Labour in opposition have responded? So, the carnival continues – round and round the same maypole, going nowhere. The difference between our trip in the TARDIS and the current position is that now there really is no money left.
The latest political performance is therefore like Samuel Becketts play Waiting for Godot. Takes up a lot of time, is hard to understand and the end turns out to be much the same as the beginning. Yawn. Could someone please wake me when it’s over?
The author, the Daily Sceptic’s in-house doctor, is a former NHS consultant, now retired.
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I think you have illustrated perfectly why people in their droves are turning away from the mainstream media.
It’s largely one-sided fear porn and takes no account of empirically derived fact, feels no obligation to justify itself, all the while accusing those it disagrees with of doing exactly the same thing.
Yep you can bet on that.
Unless, of course, that industry, organisation or company is, in some way, aligned with state ‘truth’ – then there is no cynicism to be found anywhere.
^This.
It would be interesting to test this assertion and see how many MPs do actually receive funding from the gambling industry (not just winning a couple of quid on the horses).
While we’re at it we could also assess how many MPs receive funding from ‘Green’ lobby groups.
I would wager a couple of quid that our MPs are more in the pocket of the greenies.
A tenner says you’re right on that one.
I just noticed the subtitle “Leading Britain’s Conversation”. Bit pretentious, what? Especially in the Era of X. I was thinking it stood for Left-wing Bollocks Cluster.
More than pretentious.
Clearly not a news organisation then.
”Safeguarding”
There is a repulsive, extremely modern word, the epitome of the nanny state. Overbearing and sanctimonious.
It puts everyone into 3 categories. Victim, predator and protector.
If you don’t play along and give into everything the protectors demand, then you are a bad, reckless person and basically on the side of the predators.
Not too far off topic: RIS = reconfigurable intelligent surfaces
Spying on you and you haven’t even got a mobile phone! This shit sees through walls,no kidding!
Got a router? Tick, your on!
Microwave surveillance
Radio 1 Piedophile DJ dies after falling into river!
Oh dear, how sad, never mind!
His love of pies probably contributed his death, weighed him down perhaps.
Fat floats on water.
I am always amazed when I see talk shows on different screens in the gym at how many influencers and opinion types there are. Add the bias suggested here and it would be a surprise if it were not more abused!
Wouldn’t it be refreshing if the gov’t announced the nhs GPs would now be looking at all the adverse events and deaths post covid vaxx? And perhaps offer help.
Maybe asking about the huge level of excess deaths from 2020 onwards when normal pandemic observation would say that there should be less deaths than expected as the weakest have been culled early. This pattern is seen in countries with jab levels of no more than 30% and I presume no ongoing stabby programme. That in the US a report can look at the huge increase in 25-45 deaths – you know, the prime of life – and not go near ischaemic causes is amazing.
In my experience, and I have had a lot of interaction with journalists over the years, there are a slack handful of journalists who are focused on reporting the facts and then discussing that information in a balanced manner, warts n’all. The remainder tend to the lazy and venal, frequently driven by ulterior motives and an all consuming agenda. Anyone who disagrees with their position is an enemy who must be undermined and shut down with urgency.Their ‘facts’ and ‘truths’ trump everything else. Rationality is the prime casualty. Debate is DOA. Journalism contains an awful lot of cess – time we emptied the pit.
From the NICE guidelines:
Consider asking people about gambling (even if they have no obvious risk factors for gambling-related harm) when asking them about smoking, alcohol consumption or use of other substances (for example, as part of a holistic assessment or health check, when registering for a service such as with a GP or in contacts with social services).
The moment it’s accepted that, instead of treating demonstrably existing health problems in ways proven to be clinically effective, the job of a health service is to induce behaviour change to prevent health problems based on empirically unexplained statistical correlations, the number of such behaviours will be keep growing because there’s no amount of behaviours in other people natural busybodies wouldn’t object to and no limit to statistical correlations which can be fabricated intentionally or occur by accident to enable someone to ‘prove’ that his pre-existing theories had been right all the time.
The prominent example for this is Jeremy Clarkson. He was hospitalized because of pneumonia during a holiday in Spain about two years ago. During this stay in hospital, he was (most likely) talked into giving up smoking to improve his health. It improved so much that his life had to be rescued by an emergency ateriosclerosis operation about a year later. A scientist would now conclude that the theory that smoking causes ateriosclerosis has been disproven. A lobbyist who doesn’t give a f***k about how many people end up dying spuriously¹ because of medical misinformation spread for political purpose will start to talk and wave his hands energetically.
¹ An otherwise healthy acquaintance of my mother suddenly dropped dead during a walk about two weaks ago. I can’t help wondering if his life could also have been saved by such an operation had his doctors bothered to look for early symptoms despite he wasn’t a smoker and/or if he had been a celebrity, too.
i was given some good advice over 30 years ago. “If you torture data long enough it will confess to anything”. We have to be very careful with data – it’s just snapshots of reality.