A Point of View

Friday May 15, 2020

When the Covid-19 pandemic hit the news, the lead story from our national broadcaster was (to paraphrase) “The Government haven’t bought enough ventilators, frontline NHS staff haven’t got enough Personnel Protective Equipment (PPE), The NHS can’t cope!!!!” Bla Bla Bla, etc etc.

Listening to the radio in disbelief, one asks: why was any of the above the Government’s fault?

This is reminiscent of an interview with a successful entrepreneur who owns a large string of KFC take-away shops all over the country. He explained that his business model does not really change from shop to shop, “they are all the same, we sell fried chicken”. But when he hears of public events or holidays, such as a Royal Wedding, or England qualifying for the Football World Cup etc, he reacts to the news, “gears up” and bulk buys more stock to accommodate the increase in footfall. He does not have a stratum of middle management doing this for him, he personally calls each shop in turn and lets the individual shop manager know to expect the increase of chicken. Simple!

Of course, the KFC businessman is in the private sector – where salaries and profits to shareholders are dependent upon performance and commercial expertise together with quality and profitability-related assessment, which is vastly different from being an NHS manager who is in a salaried taxpayer-funded position.

What actually is the organisational structure of the management of the NHS? Does anybody really know?

Some years ago, there was a television interview between a senior Professor who specialised in the NHS and a well-respected and very successful leader of a large group of public companies. Utilising a very large blackboard, the Professor detailed on it the “organisational line-management” structure of the NHS. By the time he had finished, it consisted of something akin to a London Underground map but with another map superimposed on top of it with extra lines and circles added.

After concluding his “presentation” and explanation, the Professor asked the Industry leader if he now had a better understanding of the workings of the NHS.

He replied, “Haven’t a clue.”

Here’s a question the BBC would never ask: Why haven’t the NHS Trust Executives, (e.g. the CEO’s paid more than the Prime Minister), ‘geared up’ and organised an increase of Chicken!!!! i.e. the ventilators or PPE needed to run their hospitals during the pandemic?

Is this not their job?

Do they not watch the news and react to world issues that might affect an increase in footfall of the Hospital Trusts they are being so highly paid to manage?

The Covid19 pandemic was identified in Wuhan, China in December 2019. Surely those running our health industry, (those CEO Trust Executives mentioned earlier), would have had an up-front inkling of what was coming before the news was released for public consumption.

You can bet your bottom dollar they know when a priceless piece of art is coming up for auction to furnish their offices. (One NHS Trust boasted of being “the largest art gallery in Liverpool”.)

Here’s part of the problem. Post 1970s, there are certain subjects that our political representatives criticise at their peril: a particular Religion, lest one might be considered phobic; Race, lest one might be construed as racist; and Gender, lest one might be accused of being homophobic.

We are now experiencing a new subject to cast a total eclipse on all the above proscribed subjects – that sacred cow, the NHS. The greatest political Hot Potato of them all!!

You might be wondering why at this moment in time, when we are relying on the NHS to literally save the Nations lives, this article appears to be criticising our carers.

Well, it isn’t.

It is, however, prosecuting a case for some serious reform of the bureaucracy and culling of the middle to senior management, who obviously aren’t cutting it.

To say the NHS is broken as it is, is not to say there aren’t some fantastic people working within it, of course there are; in fact, the vast majority are caring, dedicated, professional people. The incompetence of the leadership in some NHS Trusts, appointed purely because of their left leaning political affiliation, are most definitely not.

The NHS is the largest employer in Europe and thought to be the 8th largest employer in the world at a cost of £140bn a year; that’s 25p in every pound of central government spending.

There are some 300,000 nurses, 270,000 doctors and another 1.2 million employees. This last figure is obviously made up of other essential workers such as biochemists, radiographers, pharmacists etc. There are other essential services such as cleaners, porters and catering, though a lot of these jobs are now contracted out and are not included in the 1.2m figure.

The bill for this outsourcing is massive, far more than employing directly, as are thousands of nurses who were previously taxpayer-trained and employed within the NHS, now rented out by agencies at huge costs way above the NHS employee rate. But hey, at least these are front line costs.

What there are a lot of in that 1.2m, and costing millions of pounds without any front-line experience, are MANAGERS. If ever there was use of the phrase “Too many Chiefs, not enough Indians”!!!

The NHS Careers website lists 78 categories of manager. Here are just a few from a quick search: Clinical management, human resources management, IT and Financial management, Communications management, Green management, Diversity and Human Rights management, Art Curator and Programme manager… the list is endless. Cost-wise, the NHS employed at least 826 public relations staff at an estimated cost of £34 million, at least 165 equality and diversity staff at a cost of more than £6.8 million and at least 86 ‘green’ staff costing around £3.5 million.

Here’s an example of job vacancies recently advertised (April 2020) showing where the priorities lie with the NHS Management cult, see the comparison of wages from a frontline Nurse to a “Manager”.

North Middlesex University Hospital NHS Trust put out two job vacancies on 21st and 30th April 2020 respectively. Communications Manager £43K to £49K per annum. Nurse £27K to £34K per annum.

Makes you think, doesn’t it!

On 19th April 2020, University Hospitals Bristol and Weston NHS Foundation advertised for a….. wait for it…. Diversity and Inclusion Manager £44K – £50K per annum. Enough said.

The NHS needs a wholesale restructuring to cull these cosmetic positions and bring procurement and cost effectiveness up to the same standard as the frontline care. Trusts need to go and we should “KFC” centralise administration, saving a fortune on unnecessary managers and frivolous spending. You could pump another £20 billion into the NHS and it wouldn’t make a jot of difference. Most likely it would disappear on artwork to cover the diversity officers and procurement managers’ offices.

Why don’t we use the ‘DVLA’ as an example, who, as an executive agency of the Department for Transport, successfully run the country’s driving licences and collection of vehicle excise duty from a central base in Swansea, employing no more than 5,500 people.

OK, we’re probably looking at employing more than the DVLA to administrate our health service but let’s think about this. The Government could create a central NHS hub, somewhere in the North, bringing a much-needed boost of employment to an economically deprived area and save millions in the process.

Just think of the advantages for procurement, maybe then the NHS wouldn’t be spending millions on paracetamol, when the same drug is available to the public at a fraction of the cost over the counter.

The Coronavirus emergency should pave the way for our politicians to grasp the NHS Hot Potato once and for all; light a bonfire of all those non-essential managerial positions that have been created over years of political correctness; and have a full scale review of the financing of our health service. Maybe then the British Taxpayer would get the world-class health service currently being paid for.

One last thought…Why are we the second largest donor to the utterly useless, Chinese-controlled ‘World Health Authority’, an organisation that appointed Mugabe as a good will ambassador!

The Conservative Monday Club, PO Box 7694, Bishop's Stortford, Hertfordshire, CM23 3XR