Quality and efficiency are allies, not enemies

There is still plenty of work to do to raise efficiency and quality in various public services. Some in the public sector seem to think efficiency means cuts, and cuts means lower quality. That is not the way to do it. Doing things efficiently should mean doing them better.

If you get something right first time you avoid the costs of changing and remedying, or the even bigger costs of having to apologise and compensate if the good or service has gone out in bad shape. If you harness more machine and computing power to a good programme design you can improve accuracy and quality whilst speeding up the process and cutting its cost. Modern digital technology offers huge scope to both raise quality and cut costs if done well. It also offers new ways to mess things up and to make life more difficult for the consumer.

Let’s take the case of NHS supplies. A good system would cut down stockholding of drugs and specialised food products in the system, reducing waste from poor holding and handling, and from items going out of date. More just in time deliveries to hospitals, surgeries and users would reduce the amount of medicine or specialist food that is tipped away as unwanted when a patient recovers. Some hospitals still do not have computer controlled drug dispensing, with suitable controls over what is administered, when and in what quantities. Doing it through a drugs trolley with staff members reading the notes and then finding the medicine leaves more scope for error than a system based on a patients computer record and computerised handling of the required drugs. I have talked before about the return and reuse of hardware like wheelchairs, crutches and other aids.

There is the direction and use of manpower. Public service personnel are crucial to successful public services. Their dedication and professional skill are the essence of much of it. Not only do they need proper computer and machine back up to do their jobs, but they also need intelligent direction of effort by management who see where they are needed and can make their best input. Some managers do this well, but there needs to be a constant effort to ensure personnel are well deployed. I have seen cases where two health visitors have turned up to an elderly person facing a problem, only to discover neither of them could resolve the query. Home visits are important but are expensive, so it is crucial the preparation for them directs the right manpower to the right home to sort the issue.


  1. ian
    June 16, 2018

    Private companies would do their pudding if you started to interfere with their overordering and price gouging with bonuses for waste which would reflect in their share prices.

  2. Nig l
    June 16, 2018

    A hospital in southern England, of 50 invoices prepared to go out to private clients and insurers, a third were wrong and that is just one day. The amount recovered in a year from outstanding debtors who have not been chased for over a year because there is no dedicated resource, £200,000.

    Please table a question to the Secretary of State to publish how much is owed to hospitals in England and Wales with the dates when they were due, how much over the past 5/10 years has been written off as irrecoverable and what is lost from foreign patients, both not charged up front or irrecoverable later plus the cost of any staff that have to liaise with the Home Office.

    On the wider issue, how many layers of management are their across the Public Sector?Good practice suggest there should be four at the most. How much gets spent in the last quarter of the financial year just to ‘use up budget’ so it doesn’t get cut for the next? How many meetings are held for the sake if having them and who has done a cost/benefit analysis of them?

    Ps headlines are linking you with No tax rises to give more to the NHS. Thank you. Needed to be said.

  3. Lifelogic
    June 16, 2018

    Indeed you say:- “There is still plenty of work to do to raise efficiency and quality in various public services.”

    A huge understatement. Much of what they do is totally pointless or actually damaging anyway wasting the time of the productive sector. So many areas (for example the NHS, Education. subsidies to augment the feckless, subsidies for the unreliable so call renewables and electric cars, the selfemployed, housing) need very little input from government just a sensible tax benefit, voucher system.

    It is not their money nor they you get the value so they care not what they do or what value if any is delivered. So long as they get their gold plated pensions (about 5-10 times the value of the average private sector ones and their wages).

    So dire is the NHS system and moral that few expensively UK trained doctors want to work there at all. Only about 50% go on to work for the NHS after fully qualifying.

    Politicians & Government are the only ones who can direct them to act in the interest of the public but they rarely do. Direct them to buy votes in marginal seat occasionally perhaps. Or put out propaganda adverts on perhaps green crap, plastics, go home immigrant vans near elections or how well the government in doing at this or that area -maybe yes.

    Endless expensive drivel adverts on LBC for the appalling (Trump/America hating) Mayor of London.

    1. Hope
      June 16, 2018

      The civil service JR refers to and the inefficiency therein is down to its lease PM May! Every section of the public sector comes under a minister, each nefficiency is allowed by that minister. Every quango comes u dear a minister. The bonfire of quangos never happened and they act as a firewall for lazy incompetent ministers to pass the blame to someone else. The elephant in the room, so to speak in JRs blog is MPs. They wave through EU law, regulations nd directive without examination. They only talk about issues within parameters given by the EU or they are bypassed and the EU directive goes straight othe he quango to be implemented! Perhaps JR could explain the efficiency of having six hundred and fifty MPs and a further eight hundred Lords based on this premise. It is only second to the Chinese! May just put another eight remainers in Lords to help hold up her legislation from the HoC! Efficeincy? Come on. JR is pulling the wool over his readers eyes and protecting his useless underhand dishonest party from the public.

      I note last week Mercedes join the other German car makers for emmission failures. Why no challenge from Hammond or Gove to protect consumers and British public from this health hazard? No protest to Germany or the EU? Our beef was stopped crossing the channel. JR please explain why your govt is not protecting us?

      1. Lifelogic.
        June 17, 2018

        Indeed MPs and ministers should in theory protect and make sure the civil service, NHS, LEAs deliver value but it is a hopelessly weak mechanism. Indeed the civil service can often effetvely get the minister fired if they find them too radical or inconvenient. Civil servants have no incentives to deliver value, indeed quite the reverse. In health and education they have viruptual monopolies. As it is hard to compete when going privately mean paying three or four times over. For others in your taxes, then tax on your earning to pay your fees, then your fees or insurance and then IPT Tax on medical insurance, (VAT on school fees too if the silly Gove gets his way).

      2. Mark B
        June 17, 2018


        They are all part of the same club. A club that you, I and others are not members of. When the likes of our PM speak to the President of the EU Commission, she is not speaking as a representative of the UK Parliament and people but as a member of that club. A club that has been specially created for people like them.

        We are ‘other ‘

        1. Hope
          June 17, 2018


      3. Fedupsoutherner
        June 17, 2018

        Hope, perhaps stopping imports of such cars might focus the mind. Instead government can only tax til the pips squeak anyone buying a new diesel car costing even a pound over £40,000. No matter that the emissions might be lower than many old vehicles.

        1. Hope
          June 17, 2018

          Pricisely, as JR blogged previously about Treasury and BoE stifling our economy. Hammond happy to damage our economy in car sales but gutless to stop EU cars coming here that present a real danger to our health according to his rationale behind tax rises!

  4. Mark B
    June 16, 2018

    Good morning.

    I short – Better management. Yet some of these NHS Managers / Executives are paid vast sums to run, what is in effect, a monopoly. When one is faced with a monopoly the consumer is denied choice, a competitive price and / or a good service.

    Mr. Redwood MP sir, you talk a good game on this and I, and I am sure many here, genuinely support you, but unless you address the ‘human element’* in all this you are never going to effect any real change.

    One way to effect change is to introduce competition. That does not mean selling off the NHS. What it means is, you remove the financial burden (tax) on people having private healthcare insurance. We have insurance for our homes and contents, cars and even pets, all untaxed, so why not healthcare ? Good medical treatment is not a benefit, it is a right. I, you and everyone else has a right to receive the best medical care we can either get or afford.


    By human condition I mean, a lack of motivation resulting from no fear of potential loss. ie If you are going to get paid the same amount no matter what, why bother ?

    1. Ian wragg
      June 16, 2018

      All my insurance policies are taxed which was introduced by Brown
      Remember him. The man who destroyed final salary pension schemes for the private sector but not for the public services providers.

      1. Mark B
        June 17, 2018

        Thanks Ian

        And the Tories have done what to reverse this and other things?

    2. Narrow Shoulders
      June 16, 2018

      Quite, if medical insurance is available to all in a company it should not be taxed as a benefit.

      Neither should medical insurance attract IPT.

    3. getahead
      June 16, 2018

      Well said Mark, but perhaps the tax on private healthcare insurance is to minimise competition to our wonderful, world-beating, NHS.
      Hey I don’t know, just a thought, but tax on private healthcare insurance is madness.

  5. Peter
    June 16, 2018

    I am more worried about the waste on expensively outsourced IT systems. The NHS had a notorious experience with this. However, private enterprise was seen as ‘good’ and public service as ‘bad’. So this was overlooked. A small number of private firms had managed to cosy up to government and could be seen as doing no wrong. Until it was too late.

    It is in the nature of management to constantly seek change and pass it off as progress. Themes go in and out of fashion. Centralisation, economies of scale, vertical integration. Regionalisation, specialisation, outsourcing.

    Somewhere along the long public service got infected with the disease of very expensive cronyism. Huge and unjustified salaries for heads of health authorities, who get found out and sacked – but soon move on to a different region at a similar salary on one enormous merry go round. The same applies in local government. Certain outsourcing firms have a notorious record. We all know the names but nothing seems to change.

    Instead the blame gets shifted to the ordinary worker who probably has useful experience but is dismissed as a tea drinking, time-server as the media defer to the latest management consultants.

  6. Lifelogic.
    June 16, 2018

    One huge waste of money is where one arm of government tries to bounce a problem back and forth between the endless tentacles of the state to avoid costs in their budget and push then on to another one. Even to the extent of one tentacles taking expensive legal actions against other tentacles with tax payers funding all sides!

  7. agricola
    June 16, 2018

    Follow the lead of the vehicle industry and latterly almost all industry and adopt the tenets of ISO 9000 and QS 9000 for design manufacture and service. On the supply side employ people who know what they are buying, the industry from whom they are buying, and have an in depth knowledge of added value analysis. When that is achieved , the physical side of supply should be run on a Kanban system. Finally ,in a specific unit of activity, encourage and use the knowledge of all those involved in the process to contribute for continuous improvement. I have forgotten the Japanese word for it, it seems a lifetime ago.

    1. Edward2
      June 16, 2018

      I think that is Kaisan.
      The idea of continual improvement.
      My worry with State monopolies adopting ISO 9000 is they may create just extra paperwork and staff but never actually gain the efficiency and cost savings that result.

    2. Peter
      June 17, 2018

      My own experience of the ISO9000, Investors in People etc was that it was a glorified box-ticking exercise that adds little real value.

  8. Adam
    June 16, 2018

    Efficiency is a dimension of Quality. Leaders should direct Quality via all workers & processes, stimulating rewards for the best, & penalties for failure; aka ‘The price of non-conformance’. Errors lose traction when Quality flourishes its flush of finest.

    All products perform a service, & all services exist to satisfy the needs of the end user: the Consumer.

    Consumers are right first time. They reveal many businesses & govt parts are unfit for purpose, lacking Quality Management. Zero Tolerance of waste, crime, excessive immigration & poor service may seem over efficient, yet TOLERANCE is the error that authorises low quality.

    1. getahead
      June 16, 2018

      Except Adam where the consumer’s option of saying no does not apply as with the NHS. Where tolerance is obligatory.

  9. alan jutson
    June 16, 2018

    Its the MINDSET that needs changing in our public services, and that should come from the top.
    The very first thing that should be recognised is that users are customers, and most of them pay for those services through taxation, and as such require that service to be provided to a good standard at a sensible cost.
    Perhaps we should reward those who work within Government organisations with a bonus for working under the annual budget, instead of rewarding them to spend it all.

    If a commercial business turns in a loss it has to modify the way it does things or it goes out of business and management and workers are familiar with such.

    Government organisations immediately seem to blame a shortage of money on Government funding, and simply demand more, whilst carrying on in exactly the same manner as before.

    1. Mark B
      June 17, 2018


  10. Lifelogic.
    June 16, 2018

    Let’s take the case of NHS. A good system would clearly let people spend their money how and when they chose to (and/or insure against large medical costs). It would give them freedom of choice and they would have a moral hazard should the damage their own health with obesity, alcohol or drugs.

    This rather than the prudent being taxed to the hilt and left with the dire, rationed, take it or leave it NHS. An NHS that is killing thousands and keeping thousands more waiting in pain.

  11. Andy
    June 16, 2018

    We should always strive for public service to be high quality and efficient – nobody would argue otherwise.

    Let me highlight one shocking example of waste – Parliament.

    MPs receive lots of correspondence – both letters and, increasingly, by email. Some – Jacob Rees-Mogg for example – refuse to reply to an email with an an email. This cost paper and postage. Needless waste.

    One MP – Philip Davies – sees it as his duty to spend Fridays talking down private members bills for hours. Another, Christoper Chope, objects to all private members bills on principle – even the good ones. These people earn £77k a year – three times the salary of an average nurse – and for that vast amount of money they deliberately waste huge amounts of Parliamentary time at great expense to the taxpayer.

    On Wednesdays hundreds of MPs – among the best paid of our public servants – spend their lunchtime jeering at each other. Their food and drink is hugely subsidised, as is their travel and living costs. Vast numbers of them have second, third and fourth jobs which pay more than their first. Many still employ their partners and/or children – a practice which should be banned.

    I would have more sympathy for MPs calling for public sector efficiencies if you started by, literally, getting your own house in order.

    1. Dave Andrews
      June 16, 2018

      Blame the electorate for voting these people in.
      I would like to see a system where candidates for parliament declare their credentials and offer their services for a salary. Voters can then decide who offers best value for money.

  12. agricola
    June 16, 2018

    PS Kaizen.

  13. DUNCAN
    June 16, 2018

    I’ve been following this debate for decades. The public sector is nothing more than an highly politicised, employee vested interest. It is highly unionised and inflexible. Wasting money is essential in spending their budget allocation. Indeed, inefficiencies are a fundamental method of ensuring an expanded budget in future years. Waste is almost priced into budgets

    This whole debate is tiresome,

    We can’t rely on Labour to reform a bankrupt public sector simply because Labour and their union backers ‘own’ it. Indeed without the public sector Labour-unions would have died years ago. We therefore look to the Tories to reform this cauldron of waste and arrogant privilege. Do the Tories have the courage to confront the unions in the state sector or is May just another panderer to the public sector zealots?

    It is evident that many governments abuse the private sector to finance excessive spending on the bankrupt public sector simply because they can. We have no choice but to pay tax and therefore the public sector can make threats day after day and continue to enjoy their early retirements, security of employment, fat FS-pensions, generous employment terms etc.

    There’s no ‘magic money tree’ in the private sector. Companies either survive or they die. There’s no hiding place.

    I have witnessed the public sector spending scam for years now and nothing will ever change until there’s massive reform and that means confronting the unions. The public sector’s aim is to increase its grip, its funding and its employee numbers. Wasting our money doesn’t even register for the people that run this area of the economy. Indeed the more waste, the better

    The taxpayer is being openly

    ps And someone tell the arrogant BBC that the NHS is incredibly expensive to run and incredibly wasteful. Their NHS propaganda strategy is fooling no one. It’s just another method of politicising another state vested interest hoping to prevent rationalisation. The public sector looking after the public sector.

  14. Bob Dixon
    June 16, 2018

    The first priority is to streamline the NHS.The current Government is too busy surviving.

    1. Lifelogic
      June 16, 2018

      Alas lots of NHS patients (who could do with prompt efficient care) are not surviving.

    2. Chris
      June 16, 2018

      Yes, and focusing on body parts i.e. gender identity. Cultural Marixist agenda.

    3. graham1946
      June 16, 2018

      Agreed. There are 220 Trusts all duplicating each other in the Tory fetish for ‘Market” forces as a result of the 3 billion re-organisation of 2012 – a complete failure and mess Yet, true to the politicians code they never admit error and just chuck more and more at a failure. It needs proper re-doing and taking out of politicians malign influence. It would of course reduce politicians career prospects which is why it will never happen. Same goes for education. They should butt out – they don’t know what they are doing but still end up in the Lords House of Failures at £300 a day tax free for their efforts. Nice work if you can get it, but you don’t get it unless you are mates with the right people.

  15. Peter Wood
    June 16, 2018

    Good Morning,

    Off-topic suggestion.

    There really is only one issue that readers and contributors are interested in for the near term, may I suggest to our kind host that, instead of other topics, this blog be more of a factual update of progress and parliamentary proceedings?

    I’m not talking about the big issue such as ‘why its good to leave/stay’; the decision has been taken. What I, and perhaps other readers want to know, (that sadly the MSM doesn’t competently offer) is a what’s going on now, why is it important, who is making the running, what does it mean to the goal of fulfilling the referendum decision.
    I wish to be better informed, without bias, on the current state of progress.

    Is this possible?

    1. Ian wragg
      June 16, 2018

      Three cheers for that
      We are being kept purposefully in the dark so at the 11th hour some lousy cobbled agreement can be passed off as a good deal.
      It won’t wash.

    2. Chris
      June 16, 2018

      Very good suggestion, PW. However, I guess Mr Redwood is approaching things from a constituency MP point of view, understandably, and sounding us out on more general issues. However, there is nothing like a low key issue put out for discussion to try to damp down our anger about Theresa May?

    3. sm
      June 16, 2018

      Just go to EU Referendum News for in depth analysis; our host is an MP, not a news reporter.

    4. Mark B
      June 17, 2018

      I agree.

      I don’t care what Remainers say or think, it is what is actually happening.

  16. Dave Andrews
    June 16, 2018

    Let’s take the case of the NHS. The real problem is it’s oversubscribed by those reporting with lifestyle diseases.
    Oh, and worrying about health tourists is really a distraction from this far more significant factor.

    1. hefner
      June 16, 2018

      Twice seconded (if such thing is possible). Health tourism is only a very low (1-2%) percentage of the cost to the NHS.

      1. Ian wragg
        June 16, 2018

        That’s a lot of money.

      2. libertarian
        June 17, 2018


        2% of the current health budget is £2.3 billion which is quite a lot of money, but on the whole I agree , if the NHS wasn’t so appallingly managed they could claw back a large proportion of this.

      3. a-tracy
        June 17, 2018

        Hefner, how do you know?
        Records aren’t kept, operations and meetings aren’t costed or invoiced,
        Hospitals in London say they have many visitors treatments.

        1. hefner
          June 17, 2018

          Guardian 22/10/2013 puts it at £2bn/year. The Mirror 22/11/2016 also reports £2bn/year. FullFact.org on 21/12/2016 quotes 0.3% of total health spending, i.e. £1.8bn/year (I don’t understand how NHS spending relates to total health spending, but the three sources seem to agree with around £3bn).

          1. hefner
            June 17, 2018

            Oops 2billions

  17. Leslie Singleton
    June 16, 2018

    Dear John–I tried to pay a parking charge yesterday and had no choice but to fall in line with the rapid-fire multiple choices of a computerised payment system, this after realising there was no longer the ability to pay by cheque. In fact I had incurred two tickets in different local areas (Busy day!) and I initially thought I might ask a human whether I could send a single cheque but there was no ability to talk to a human, the thing going straight in to an automted sequence. If that weren’t enough, the automatic message said on one of the tickets (not the other) that my parking ticket number was not recognised and I was stymied, with (at the time–it worked next day) no means to proceed. The fine had to be paid and I seriously contemplated going in to a Police Station for advice. Apart from all else I resent having to give out my Bank details over the phone. No doubt the perpetrators regard this as “Efficient”.

    1. Lifelogic
      June 16, 2018

      Efficient mugging of you and your time, but alas if make you less efficient and distracts you for you business. Making the economy less efficient and thus reducing the tax base and the tax take.

      Much of what the state does is pointless or worse & you do not want them to be efficient at the pointless or damaging things. just to stop doing them.

  18. nhsgp
    June 16, 2018

    Get Amazon in to run the NHS logistics.

  19. billR
    June 16, 2018

    Yes quality and efficiency is about doing things right but can be looking for perfection

    effectiveness is about concentrating on the right things – so to get the best overall results

    Some few managers have it- some have to be trained- then there are the others- the time servers who have no interest?

  20. Iain Gill
    June 16, 2018

    Been in the head office of a nationalised industry a lot recently.

    It is like a ghost town on a Friday, managers only work 10 till 4 at best the rest of the week.

  21. English Pensioner
    June 16, 2018

    There will never be any improvement whilst management staff are all promoted from within or shuffled from one NHS Trust to another regardless of ability. All senior posts should be advertised and open to people with management experience outside the NHS. Only then will you get changes and improvements.

    1. hefner
      June 16, 2018

      They are advertised, simply not in the DM.

    2. Chris
      June 16, 2018

      They are all recycled, which means they are effectively approved of. So, no surprise that they carry on applying their, in my view, flawed groupthink.

  22. Turboterrier.
    June 16, 2018

    Just in Time JIT, Right First Time RFT are well tried and practised processes within industry and manufacturing. Its success hinges on the work force being fully trained to enable both processes to work throughout the whole of the customer/supply chain.

    On a recent visit to the local A&E following my wife’s operation on a hip replacement from which she had been sent home three days previously had all the signs of the start of an infection starting up. The first doctor examined her and went to the cubicle cupboard to get swabs, made her excuses and 4.5 minutes later arrived with swabs to take cultures. In between times nurses were in and out taking things out of the cubicle cupboard for use in where they were working. One routine operation and neither RFT/JIT had been practised.
    When questioned about what would happen if a major incident suddenly happened and all this equipment was needed the nurses replied ” always like this on the end of the shift and the new shift have to organise the replacement of stock” When asked why it was not done on a JIT basis replaced as and when used the rely was ” we haven’t got time to do things like that as we have patients to attend to. The fact they were spending time jumping around the department to get what was needed was accepted as normal method of operation, Duly got sent home being told by the consultant that is was very minor and the body was well equipped to resist the minor infection.

    Less than 24 hours later back in A&E with now an infection getting out of control. So much for the previous visit with no RFT practised. Because of the high concern being shown by myself we were placed in a side room and still the errors continued with lack of monitors and what now had become essential equipment and supplies.The saving grace in all of this that all rooms and cubicles have clocks on the wall so one can start to add up the waste of time by not having JIT/RFT processes indoctrinated in your staff at all levels.

    For JIT/RFT to be a success the whole organisation has to be trained so it becomes second nature. Everybody from the Porter to the Surgeon and the Directors have to be trained in how to deliver such processes 24/7 it is the only way it can work. It has to become an integral part of nurses training. The whole ethos of the NHS has got to change dramatically in that everybody has to taken on board they are a part of a billion pound business for all intents and purposes and until people are trained in the importance of getting it RFT/JIT all the time, politicians can throw money at it until eternity and it will not make any difference.

    The NHS needs people that can know the difference between a solution and what is the real problem, not in the medical field, but in the way they operate in the day to day management of each and every department.

  23. DUNCAN
    June 16, 2018

    I do not exist to finance the golden plated privileges of the public sector vested interest

    If May and Hammond want to abuse the private sector to ‘buy off’ the whingeing public sector employee-unionised vested interest then they’re putting this nation on the road to bankruptcy

    The public sector vested interest is NEVER satisfied with how much money they spend (waste)

    We have only the Tories to reform this bankrupt employee vested entity.

    Labour’s client state MUST be attacked and reformed before the private sector becomes little more than a supplicant of the unproductive in the UK

    To listen to the author calling for more funding of the cauldron of waste that is the NHS is just how far the left have changed the nature of the political state

    Get a grip John

    1. graham1946
      June 17, 2018

      ‘We have only the Tories to reform etc.’

      Duncan, the Tories have already done it as recently as 2012 and made the mess it is today. Do you really think they can make it better if they have another go? Politicians are by nature ‘Jack of all Trades and Masters of None’.

      It need re-doing properly by people who can do it. The money required could also be greatly reduced if the Government bought out the Trusts PFI contracts which were inflicted on the NHS by politicians of both stripes because they didn’t want to borrow money to fund hospital building which they could have done for a fraction of the cost. Some Trusts are spending half their money funding the lifestyle of fat cats in the City, rather than treating patients. Look there for some answers rather than just slagging off the staff, which is the only thing keeping it going at all.

  24. If it works, stop it
    June 16, 2018

    We accept computer system updates actually creating problems not least in the systems themselves. Arrogantly, we consider we are a cut above IT “experts” in specialist “IT Departments”. Don’t we just love to think and didn’t we just love to say “If it works, don’t fix it!” ?

    We love outsmarting extremely competent and intelligent people. They are. Not enough of them, really not enough of them, are sacked never to be employed again in responsible positions of any kind, even jailed. They make far less errors than we think
    No, these are not teething problems, they are not genuine errors. One can write a book as to their motives and those who employ them.

  25. Denis Cooper
    June 16, 2018

    Off-topic, the Telegraph is claiming today that Tory rebels are leading us towards “Brexit in name only”, but has it occurred to the rebels that even “Brexit in name only” is still Brexit insofar as the UK will no longer be an EU member state – viewed from the EU it will become a “third country” – and all of the numerous subsidiary and side agreements which are now predicated on the UK being an EU member state will still need to be adjusted if a disorderly withdrawal is to be avoided? Certainly there could be temporary or provisional adjustments, just simple agreements that for the time being the same terms will continue to apply as if the UK was still in the EU, but eventually they will all have to be regularised. So if the Tory rebels claim to be fearful of queues of trucks stretching for many miles and the country running out of food and medicines and all air traffic coming to a halt, etc, then they should be asked how aiming for a very poor final state, “Brexit in name only”, will assist in preventing those terrible problems they imagine will occur during the transition, in the days and weeks after our EU membership has terminated. Is it because they think their chums in the EU may be more co-operative about avoiding any unnecessary chaos if we agree to accept a vassal status, rather insisting on a clean Brexit?

    1. A.Sedgwick
      June 16, 2018

      With the barmy Remoaner forecast of our running short of food, it will be another win for the NHS with obesity levels dropping dramatically.

    2. Chris
      June 16, 2018

      Well done, Denis, for your persistence in pointing out the flawed thinking and stupidity of the Remainers.

  26. sm
    June 16, 2018

    I was interested to read the other day in a serious article about the NHS that productivity decreases as budgets are increased.

    More importantly, surely in any organisation, public or private, profit or non-profit, what really makes a difference in efficiency and quality is how good is the leadership?

    Whether it’s a headteacher, managing director, site foreman, constituency association chairman, matron or Prime Minister, good work will spring from one person’s quality of example and leadership.

  27. BenM
    June 16, 2018

    Mrs May might get away with the double cross on Dominic Grieve but we can be sure of one thing the Brussels crowd is looking on- and she won’t get away with any of this or similiar type shenanigans when it comes to Barnier- so DD had better watch out –

  28. nigel seymour
    June 16, 2018

    To Whom It May Concern. Until England exit the World Cup I’ve absolutely no interest in Brexit nor upskirting nor Wera Hobhouse nor SNP nor Trump NOKO nor anything nor nothing…LETS GO THREE LIONS!!!!!!!!

    1. hefner
      June 16, 2018

      Yeah, way to go!

  29. ian
    June 16, 2018

    I see that home secretary has relaxed rules on tier 4 students, No need for the right qualifications or speak English and have to show that they can support themselves, he has also made it easier for people from non-EU countries and refugees to live and work here.
    This on top of new rules for doctor and nurses from outside of the EU, a free for all.

    1. Chris
      June 16, 2018

      True Tories should be questioning and challenging SJ, but instead the Party is apparently hailing him as a future leader. The Tories really do not get it.

  30. NickC
    June 16, 2018

    JR, The public sector is so huge that it has it’s own agendas, quite out of control of the politicians. There’s too much managerialism in the public sector. Too many “targets”, too much time-and-motion type micromanaging, too many managers, too much bureaucracy, too little reliance on the professionalism of the people who actually provide the service direct to the public.

    And at the top of the pyramid the politicians who control it all (or are meant to) don’t actually. The local and central government bureaucrats run rings round the politicians, or cover up what they’re really doing, or tell Ministers what they want to hear. That’s why junior doctors and GPs from different areas tell me one thing, and Jeremy Hunt tells me another.

    It is why, when the civil service are asked to implement Leave, they give us Remain.

    1. Backtoback
      June 16, 2018

      Nick C..we should try to bring back matrons and sisters to the hospitals, .they were motivated by vocation ..the current NHS middle manager types are motivated by career advancement, salary and retirement packages. Too bad

  31. APL
    June 16, 2018

    In the Theatre of the absurd, otherwise known as Westminster, the latest cabaret starring Christopher Chope who seems to have been volunteered ( in the manner of the British Army of old ) to object to a ban on so called ‘up-skirting’.

    It seems the feminists are up in arms because the hapless Mr Chope has caused the bill to fail on a procedural matter.

    The BBC and loads of Government paid Feminists are ‘up in arms’ because the hapless Mr Chope has done a bad thing.

    Notice the BBC, the Feminists and MPs are almost utterly silent about the several thousand underage girls** who have been raped by gangs of …….. males. In our main metropolitan cities.

    Why the Police can’t return a conviction against a man who has engaged in sexual activity against a girl who is legally incapable of consent is almost unbelievable.

    But this is Britain in 2018, you can’t allow your children out on the streets because they may be abducted abused drugged pimped and raped, yet the Police will come down on anyone who says something mildly risqué on Facebook, like a tonne of bricks.

    What an utter shambles.

    1. The Prangwizard
      June 16, 2018

      Indeed so. No-one in authority is listening; they do not wish to change our country’s direction of travel. These people have been described as liberal authoritarians brooking no opposition, with the police and the jusiciary on their side. I prefer to call them liberal fascists. Censorship is everywhere of course.

      Either way our country is lost unless we fight.

    2. Lifelogic
      June 16, 2018

      Indeed and silent too on the appalling failures at the DPP – failing to release evidence to the defence of clearly innocent men.

      Then when it finally comes to light they are clearly innocent they still tax years to actually release them.

    3. Chris
      June 16, 2018

      Quite right, APL. Reversed priorities. Welcome cultural Marxism.

  32. Denis Cooper
    June 16, 2018

    Off-topic again, I see from the headline in the Sunday Telegraph that Christopher Booker is still determined that we must somehow remain in the EU Single Market.

    This is because the 6% of UK businesses which export 12% of UK GDP to the rest of the EU would find it more convenient for their vested interests if all of us, every business and organisation and person in the UK, remained subject to EU law.

    And of course without us having any meaningful control over immigration from the EU, the EU Single Market being based on the four inseparable fundamental freedoms, one being unfettered freedom of movement of persons.

    The supposed “total deadlock on the Irish border” – over which UK exports worth just 0.1% of UK GDP pass – being the current excuse for this patent folly.

    A “total deadlock” springing from the repeatedly expressed determination of all sides – the UK government, the Irish government and the EU – to keep that unique border completely open, with movement of persons and goods just as unhindered as now.

    But in the case of the last two only if the first agrees to its continued legal subjugation, and in the case of the first with the Prime Minister having already sold the pass by accepting that it is our responsibility to ensure that the other two will not behave like idiots.

  33. Me
    June 16, 2018

    A number on here write from time to to time “I’ll never vote Tory again…because…” Possibly they’ve never voted Tory in their lives. In all honesty I did in the last Election and perhaps only once before.

    So the Tory Party has not lost a great deal also because I live in a rock solid Labour seat. But I will not vote Tory while Mr Javid is Home Secretary…or persons of his view in the same position. I have very strong opinions against Cannabis. I will not vote for a party anyway which has a minister who overrides any democratic procedure and by so doing legitimises the Undemocratic and, in this case encourages the acceptance of this narcotic. ..which has killed my friends of yesteryear. All of them!

    1. Mark B
      June 17, 2018

      A very honest post.

      Thank you.

    2. graham1946
      June 17, 2018

      The life of a child is more important than ‘democratic procedure’. He is to be applauded for doing the sensible thing and allowing this under medical supervision. The type of Cannabis you refer to is very different. Shame it took all week and the almost death of a child and was only done then because of media pressure.

      1. Me
        June 17, 2018

        An international lawyer informs me EU law and not just British law and indeed Canadian law interplays. I do not know yet whether Mr Javid will answer for his actions outside our borders even if it takes years as the action took place whilst we were members of the EU.

      2. Richard
        June 17, 2018

        I agree. Medicinal cannabis already prescribed for Multiple Sclerosis & its also undergoing clinical trials (FDA seem likely to approve) for epilepsy. https://www.reuters.com/article/us-gw-pharma-cannabis-epilepsy/gw-cannabis-derived-epilepsy-drug-gets-positive-fda-staff-review-idUSKBN1HO245

        I hear illegal cannabis (causing mental health problems) is a lot stronger.

        1. Me
          June 18, 2018

          There would perhaps be some sober support for the use of a drug if it, and the many champions of its use “for medicinal purposes” did not also have a secondary agenda of its legalisation beyond medical use.And they have.
          Its theme runs with all “social” drug abuse. It is literally in the nature of the spread of narcotics psychologically. The carriers as it were, use their intelligence and social position to promote it. “Look it hasn’t done me any harm, its just a herb, it gives me pleasure, it is friend-making, a social past-time” . When the sales-pitch does not completely work , the “Must-Have-It goes on to say “Helps you work rest and play””It does you good!” “It helps stop heart disease because of its tannins ” etc etc etc.
          Like all nasty drugs it jigsaws into human psychology and expertise to justify itself. It does not have a mind. It acts like a virus attaching itself to individual and then groups of “cells ” ( people ) changing their fundamental DNA, literally sometimes and certainly neuron interactive structures, and so takes over. Then it is too late.Resist, resist your own propaganda!!! It is not your OWN really. It is not YOU, but a “modified” YOU. People who have got off the drug can and do confirm.

  34. Richard
    June 17, 2018

    The UK has an efficient business sector, where ‘ continual process improvement’ & ‘doing less with more’ have been necessary for 20 years. There is much there that the NHS might emulate (IT systems, processes, internal controls, internal audit cycle, lean six sigma).

    The NHS should hire more of its managers from the business sector.

    1. Richard
      June 18, 2018

      meant ‘doing more with less’

  35. David HOLLINS
    June 17, 2018

    The NHS spends £6.8m per year on diversity advisors, so they can start there before they demand tax off me to finance their wasteful ways.

  36. margaret
    June 20, 2018

    I started working in the NHS in 1968. I have been a student, a staff Nurse, a sister, a practitioner , a lecturer, a manager and now an ANP. Every single one of those days needed some type of study related to practice whether it was clinical or ethical.My roles are professional: we put our lives into it and are fully accountable for our own practice: we cannot blame the Dr if we do something wrong.If we say the Dr told us to do something wrong and we did it, then this is no excuse.My ward was closed and I had to work agencies combined with another P/T job for 15-20 years. I worked in every discipline in surgery and medicine taking charge of hospitals and at other times doing the role of a carer. My clinical skills were well used.
    In all that time quality is what we strive for and believe me this is difficult with those who have qualified or practised in other countries. Efficiency though is not the same as effectiveness.We can see many sorting out the problems with seemingly alacrity , but causing chaos further down the line.

    It may be a good idea if rather than getting hoards of Dr’s from overseas if we appreciated our Nursing staff and stop saying it is the Dr’s job for this and that when in actual fact the Nurses who frequently diagnose , organise and treat patients. We do not wish to replace Drs but acknowledgement of our roles would help with morale as we teach Dr’s our Job role.

  37. a-tracy
    June 21, 2018

    John, don’t you wonder who does the charging systems for private hospitals and doctors, what software is written for them? If the software is already designed why not offer these software companies the opportunity to run the billing admin departments in hospitals so you don’t use medical staff at all and give them a % of the billings. Even if this is done in the main City hospitals to start with, especially London and Health services are charged back to the EU and netted off against what we owe the likes of France and Spain for medical care covered by the EHIC card it will pump millions back into the hospitals providing the service, so they can hire and train more of their own staff.

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