Simply throwing money at the NHS won’t solve all its problems | Simon Jenkins

Billions will be wasted as long as the health service remains hyper-centralised and disconnected from local authorities

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


Simon Jenkins

The GuardianTramp

Related Content

Article image
Bossy diet advice won’t save the NHS | Dawn Foster
The idea that disadvantaged people place undue strain on the system won’t go away. But the problem is underfunding – not people who eat too many chips, writes Guardian columnist Dawn Foster

Dawn Foster

22, Jan, 2018 @6:28 PM

Article image
Yes, the NHS is fractured. But competition won’t heal it | Polly Toynbee
The latest NHS reorganisation has reawakened fears of privatisation. Only a Labour government can bury them once and for all, writes Guardian columnist Polly Toynbee

Polly Toynbee

19, Feb, 2018 @6:00 AM

Article image
On mental health, the Tories need to put their money where their mouths are | Alastair Campbell
David Cameron and Theresa May have said all the right things about improving the nation’s mental health. Yet people aren’t getting the help they badly need

Alastair Campbell

18, Jan, 2017 @10:30 AM

Article image
How many nurses' salaries does it take to redecorate Downing Street? | Marina Hyde
It’s the standard unit of measurement for top football signings – and can be usefully applied to political expenditure too, says Guardian columnist Marina Hyde

Marina Hyde

05, Mar, 2021 @1:53 PM

Article image
I’m proud to be called a junior doctor. Titles are the least of our problems | Rachel Clarke
We desperately need more doctors, more beds and more resources, says junior doctor Rachel Clarke

Rachel Clarke

10, Oct, 2017 @3:57 PM

Article image
I’m quitting as a hospital boss: dire NHS funding problems give me no choice | Bob Kerslake
Our deficit at King’s College hospital, London, means we will be put into financial special measures, while what the NHS really needs is a fundamental rethink, writes Bob Kerslake, former head of the civil service

Bob Kerslake

10, Dec, 2017 @5:59 PM

Article image
NHS waiting lists could top 15 million in four years without major rise in capacity
Overspend of at least £5bn likely, says Nuffield Trust – but cabinet is deeply split over size of future funding settlement

Michael Savage and Denis Campbell

07, Aug, 2021 @11:02 PM

Article image
With Jeremy Hunt working to save his skin, no NHS boss is safe | Polly Toynbee
Bob Kerslake, one of our best health officials, has been ousted on a minister’s whim, writes the Guardian columnist Polly Toynbee

Polly Toynbee

11, Dec, 2017 @8:15 PM

Article image
My cancer operation was cancelled and I can’t sleep at night. Jeremy Hunt, how can you? | Carly O’Neill
Why won’t Jeremy Hunt fight to get the NHS the funding it so desperately needs, asks Carly O’Neill

Carly O'Neill

09, Jan, 2018 @5:20 PM

Article image
Waiting for an ambulance, unable to breathe, brings austerity home | Frances Ryan
It only takes a moment of being in need to make cuts frighteningly real. The tipping point must be coming, writes Guardian columnist Frances Ryan

Frances Ryan

08, Feb, 2018 @8:00 AM