When the NHS is so poorly managed, no
amount of extra money will fix it

“I have never come across any business that measures its success by the amount of money it spends. Yet, all too often, that is precisely what government does. Increased financial commitment to the NHS is provided as proof of emotional commitment to universal health care: I spend, therefore I care. In the private sector, the entire mind set is different: outcomes are everything; what matters is the service received by the customer.” – Jeremy Browne, Race Plan.

So much of the debate about healthcare focuses on how much we spend on the NHS. But increased spending is no guarantee of good service – indeed, as Jeremy Browne hints, focussing on money going in often serves primarily as a distraction from the service individual patients receive. I won’t go over that ground again, but it’s how things like Mid-Staffs happen.

A broken healthcare system eats up money, with no visible improvement in care – or else small improvements that do not justify the increased costs. Worse, pouring money in helps to hide the problems. Focussing on budgets alone helps poor managers hide their lack of business skills, poor procurement practices, and terrible people management.

The truth is, the NHS wastes an awful lot of money. This week, the Daily Mail did an excellent expose of NHS managers’ pay, revealing pay rises of £35m last year. I don’t object to high pay in principle: if someone does a great job and is worth £1m a year, then they should be paid it. But the NHS doesn’t work like that. These managers are earning vast sums of money unconnected to their performance, and many high earners in the NHS head up poor performing hospitals or have even been sacked from previous posts.

But the waste doesn’t stop with managers’ pay. Earlier this month, the Health and Social Care Information Centre reported that millions of pounds a year are being wasted on prescriptions by GPs for over-the-counter items such as sun-cream, toothpaste and multivitamins.

It goes on. £2bn a year on unnecessary treatments and tests, a £1.5m cancer treatment unit built and not used for two & a half years, sex-change surgery for a 78-year-old (I wish you well Ruth, but not on my tax-pound), and the £46m uncovered by the TaxPayers’ Alliance which is spent on spin-doctors, diversity consultants and ‘green’ staff.


Poor people management, bad forward planning and difficulty recruiting have led to the use of agency and locum clinical staff – to the tune on £2bn in two years. A lack of basic business skills, joined up thinking and sheer disregard for taxpayers’ money means around £1bn a year is wasted through bad procurement practices, as hospitals pay wildly different amounts for the same product. What’s more, the poor standard of care is evidenced by the £22.7bn set aside for litigation and compensation claims.

My argument is simple: more money will not fix these problems. ‘Our NHS’ is a dysfunctional and bureaucratic nightmare; centralisation, distorting targets and cast-iron employee protections make it easy for incompetence to hide. It is Ayn Rand’s vision of a government where no one takes responsibility for problems and no one is accountable for their decisions.

Often, NHS managers are slated for being too business-focussed and not caring about patients. I have news for you: many, many managers do not care about patients at all, but even more of them have no business skills. These are the types of people who pay list-price for an item they are buying thousands of, with no attempt to negotiate a discount. They are the people managing departments but rarely actually visiting the services they are responsible for, nevermind speaking to the staff on the front-line. They are the people so busy bitching and bullying each other that they forget about the real people who suffer through poor care on their watch. These are the sorts of people who choose equipment based on upfront cost, rather than thinking about the bigger picture of patient outcomes and further care needed down the line.

We need to reward managers who maintain a laser-sharp focus on patient outcomes & value for taxpayers in every decision they make. Of course budgets are important, but no amount of money in the world can buy that kind of competence whilst everything else stays the same.

To get managers who deliver for patients, we need structural and cultural change in our health service – and it’s about time we admitted it.