Regular readers will know that I have often been less than complimentary about how politicians run the health service. My analysis comes down to the fact that our political system is broken.
This disease is hardly restricted to the UK with our long-time allies across the pond shaking their heads in disbelief as their President systematically trashes their reputation. Our political system is based on Party Politics, the Party comes before all else.
To become Prime Minister your Party has to get elected and you have to be elected within the party. The ability to stick the knife in the back of others is key to personal progress – this same ability serves politicians well when sending people to war or making tough decisions regarding funding cuts.
Parties, however, know that to get elected you have to have populist policies, being an idealist out of power means you will achieve nothing. Populist policies are the domain of the press and in the UK that is the Daily Mail. So here is the rub, the popular press sets the agenda for policies which politicians pander to. And underlying all of this is the mantra that public money cannot be wasted.
It is an interesting fact that successful companies such as Amazon or Microsoft consider a success rate of 1 in 50 for new ideas to be commercially ok. Public institutions encouraged by media outrage consider a failure rate of 1 in 50 warrants the sack if not imprisonment or worse.
Over the years I have found the only thing which seems to make any sense in the running of the NHS is that most initiatives are launched on Aprils Fools Day. I have worked within it for 30 years. For the first decade the problems were chronic underfunding coupled with consultants having too much influence over hospital budgets. Then along came Mrs Thatcher’s government who introduced the concept of the internal market.
The 1980s were a heady time for those economists who believed that simply leaving markets to themselves would have a Darwinian type impact in which only the strong would survive. The solutions to the ills of the NHS was obvious if only we could unleash that same power and energy then we would get the best and cheapest health service in the world.
But even a 5-year-old could explain the problem with this logic, the NHS is not an open market – all of the money comes from the same source – taxpayers. Allowing hospitals and GPs to compete with each other was fraught with difficulties. Couple to this the idea that making a personal profit in the private sector is a laudable goal and indeed is one of the main goals of being an entrepreneur but making a profit in the NHS is sinful and surely should be illegal (according to most of the media).
So over the last 20 years we have had a number of private and successful entrepreneurs turn their hands at running NHS institutions and all fail – mainly because they have their hands tied behind their back by NHS bureaucracy. I have lost count of the number of times we have been urged to work smarter not harder. The NHS has been so trimmed to the bone that it is anorexic – but the regulatory bodies such as the CQC which destroy morale seem to be engorged with funding.
The solution to the NHS is obvious, take politics out. Have a separate ring-fenced tax system which is not at the whim of the chancellor. But to do this also requires that the politicians need to be able to resist calls from the media to hang, draw and quarter people when errors happen.
Get rid of the regulatory bodies. Let the professionals and managers simply run the service as it needs to be run. If when we have done all this the NHS is still too short of money to provide all the care that we need, then we need a public debate about what should and shouldn’t be funded – this is one thing for which a referendum may actually be quite reasonable.
If the politicians should bite the bullet, they should also consider de-politicising education as well.