Watch the news each day and you might regard Britain’s NHS as a black, swirling pit into which ever vaster sums of money constantly vanish. All it does is answer back with screams of hospitals near collapse, queueing ambulances outside hospitals, year-long waiting lists, postponed tests and staffing crises. The chancellor, Rishi Sunak, obsessed with daily headlines, hurls billions of pounds at it, to no obvious effect.
Those who know the NHS all say the same. The NHS relies on the public thinking it wonderful, and as a result all it needs to do is demand money from the government. In 2007, the businessman Gerry Robinson made a celebrated documentary about trying to run an NHS hospital. At the end of a working day, the camera caught him getting into his car and collapsing into tears of frustration. The reason was not money. It was the opposition of the entire senior staff to any measure that might improve their performance or render their work more efficient.
A classic issue is whether GPs, whose surgery productivity has been improved through the use of telephone consultations during the pandemic, should be forced back to in-person appointments, as the NHS is insisting under political pressure from the government. Elsewhere, the health service has long neglected specialist testing centres, plentiful in the private sector, for taking work from its hospitals. The result is tests delayed for years, and Sunak now rushing to build new centres.
The NHS’s age-old rivalry with local government has blinded it to local elderly care as critical to its performance. Yet, in the early stages of the pandemic, it simply cleared elderly hospital patients into care homes, where thousands died and thousands more had to return to hospital. The pain – and cost – must have been enormous. As for the seven Nightingale hospitals created to treat Covid victims last year in a blaze of political publicity, they were largely unused.
In all big public service organisations, value for money becomes impossible to measure. The NHS has long sought comfort in hiring cohorts of management consultants. Hundreds of millions have gone to firms such as McKinsey and Deloitte: vast sums of money spent with the supposed aim of saving other sums of money elsewhere. I know of no estimate that says a penny was worth it, yet no account is ever given.
Challenging a public service to behave efficiently does not mean challenging its ideological status. Public healthcare is good. But in many countries across Europe, it is integrated with local government and in most cases is administered locally and without the chaos surrounding the NHS. Such processes also deliver outcomes that are often superior to those of Britain’s hyper-centralised system.
The last thing the NHS needs is another “reorganisation”, as Sajid Javid promises. But it must reassure the public that it cares for efficiency if support is not to wear thin. “Protect the NHS” is Boris Johnson’s war cry. But protect it from whom?
Simon Jenkins is a Guardian columnist