Working smarter and better

Most people think boosting productivity is a good thing. If you increase the amount of goods or service each individual worker can produce you have a more efficient economy and pay can rise to reflect the boost to output.

Now that the NHS is taking such a large amount of the national budget and a substantial share of total public spending, the issue of working smarter and better in the NHS has returned to prominence. According to the ONS NHS health productivity fell by 0.8%, the last year (2019) before the pandemic disrupted it. In the period 1996 to 2019  NHS productivity advanced by 0.7% per annum, or a bit faster if you make a quality adjustment to the figures. This is a disappointing result given the ability to use digital technology to boost output through more remote consultations and the growing efficacy of some less invasive treatments.

Quality and efficiency are two sides of the same coin. Get things right first time and there will  be no remedial pains and costs. Eliminate hospital carried infections and cut the workload. Recruit and train more nurses and doctors who share the aims of each  Trust and wish to be regular employees, cutting back on the need for agency staff. Encourage specialisms so skilled teams become excellent at elective treatments  through regular experience from specialisation. Fashion  protocols for additional  less invasive treatments. Adopt more medicines with good test results for treating conditions. Cut waste levels in the use of drugs, surgical and nursing products and medical equipment.

We are still waiting for the plans to spend the extra money for the waiting list reduction and the manpower plans. Why don’t we get extra hospital beds capacity for all the extra money? The Health Secretary needs to challenge the NHS CEO more.



  1. Everhopeful
    November 24, 2021

    Apparently our”Health” authorities can’t even cure or resolve a corona virus. Atishoo.
    Why are they so desperate to anyway?
    They know it is an impossible task …like curing the common cold because whatever causes it always mutates.
    They need to go back to the drawing board.
    Or stop p*ssing us about.
    Or just bloody well leave us alone!

    1. glen cullen
      November 24, 2021

      This government and the NHS have to justify the £37bn spend on ‘track n’ trace’ somehow

      1. Everhopeful
        November 24, 2021

        Ooo yes!
        And apparently our DNA from the swabs is being sold.

      2. Paul Cuthbertson
        November 25, 2021

        GC – similar to the billions we give to the Paris Climate Accord, the government will not tell you where the the money is spent and it “aint” on climate change.

    2. Nottingham Lad Himself
      November 24, 2021

      The scientists have never left the drawing board.

      They know that there is plenty that they have yet to learn about this virus.

      For instance, what the likely spread of possible mutations might be, how dangerous these would be, and the extent to which a given vaccine would protect against them.

      The work will continue.

      1. No Longer Anonymous
        November 24, 2021

        As with all known viruses.

      2. Micky Taking
        November 25, 2021

        ‘what the likely spread of possible mutations might be’ – not the daydreaming of scientists, but the Government appointed department nonsense that often comes out as ‘forecasts’.

    3. jerry
      November 24, 2021

      @EH; “Apparently our”Health” authorities can’t even cure or resolve a corona virus. Atishoo.”

      None so blind as those who choose not to open their eyes!

      “They know it is an impossible task …like curing the common cold because whatever causes it always mutates.”

      Unlike CV19 there are many remedies for the common cold, like CV19 there is only one protection from the common cold, not being exposed to the virus as far as possible (such as wearing a mask in enclosed spaces or not entering such places unnecessarily).

      But I do agree, the govts miss-selling of the CV19 vaccination will become problematic over winter, far to many people seem to behave as if the vaccine is a “cure”, something that has not been found yet, unlike as I said with the common cold. In fact those who are vaccinated and believe themselves immune, if not the pandemic over, are the real danger now, quite possibly asymptomatic yet still infectious – hence the govts now asking people to take lateral flow tests before visiting relations or seasonal events.

      “Or just bloody well leave us alone!”

      No one is stopping you from harming yourself, out of willful ignorance, just don’t expect others to follow your lead.

      1. Paul Cuthbertson
        November 25, 2021

        jerry – The real conspiracy theorists believe their government cares about them, the media would never mislead or lie to them and the pharmaceutical industry that makes billions from sickness wants to cure you.

  2. Javelin
    November 24, 2021

    Get rid of the management consultants from the NHS. That will give you a 5% productivity boost.

    1. lifelogic
      November 24, 2021

      Test and Trace spent £billions and surely gave a net negative value to the public on any rational analysis. This is hardly sensible for health productivity?

    2. Peter
      November 24, 2021

      Certainly get rid of the management consultants and also the overpaid layers of NHS management.

      Unfortunately the opposite is happening. The big accountancy firms are making even more money from the NHS. To do so they reinforce the claims of NHS management that even more money needs to be spent on bureaucracy. There is no outside challenge to this set up.

    3. Nota#
      November 24, 2021

      @Javelin Only 5% it will save more than that in reduced empire building paperwork, considerably more than that in expenditure.

  3. Mark B
    November 24, 2021

    Good morning.

    How do you measure efficiency in what is a monopoly ? How can you measure efficiency in what is an area of public life that can only be measured by success and failure and, the variable of which too numerous to go into ? To answer my own questions, you cannot !

    If you had two business selling the same thing then you can compare. For example, the car industry. British , American and other European products when compared to Japanese ones in the 60’s, 70’s and 1980’s where both inferior in reliability and in price. The Japanese, despite having no natural resources such as iron and coal, could make them cheaper because they were more efficient. A direct comparison can be made.

    Perhaps if we were allowed to have a choice so that we could choose, then we could see for ourselves and not rely on a government QUANGO with a dodgy track record of producing figures ?

    1. lifelogic
      November 24, 2021

      The best way is to compare health outcomes for certain conditions (certain cancers, heart conditions, diabetes, sepsis, gall bladder problems, maternity… and waiting times for hips, knees, back … operations ) with other countries.

      The NHS comes out rather badly when you do this. Like most state run monopolies it performs very inefficiently indeed kills thousands and fails millions.

    2. Oldtimer
      November 24, 2021

      It should be possible to compare the operating efficiency of different NHS health trusts just as a Ford or Toyota compare the operating efficiencies of their factories and sales and marketing operations. It depends on selecting and comparing the relevant operating activities, the costs of performing them and then digging into the data to understand the reasons for the differences and how they can be improved. It would involve gritty encounters with poor performers but that is what is needed.

    3. Nig l
      November 24, 2021

      Top answer plus does any one think a life server of 25 years plus can really bring the fresh eyes needed to come up with anything other than ‘more of the same’?

      There is zero/little performance management across Government starting with Boris who hasn’t a clue. The head of procurement in the MOD recently received an eye watering bonus of £150000 despite massive failures/losses/delays on most programmes, tanks being the most notable.

      I suspect that is the norm across all departments, bonus being an automatic salary addition rather than actually performance managed.

      I look forward to Sir JRs enlightenment. It’s a topic that has hacked off the public for years.

    4. jerry
      November 24, 2021

      @Mark B; I though the private health industry was the competition to the NHS, how many times have we been told they are more efficient than the NHS, are you saying such people are comparing chalk and cheese?

      To answer my own question of course they are, the NHS treats whoever turned up, whatever the time of day, whatever the injury, your beloved ‘competition’ have been around long enough to have created their own A&E departments, their own children’s hospitals, run their own industry wide 999 service etc, but they have not as they know they would go bust very quickly, or would have to ration who they treat -as they already do with some polices were those with per-existing illnesses are refused cover, or load the premiums…

      As for Japanese motor cars, especially back in the 1960s and ’70s, well if your only judge is price… 😮

    5. Nota#
      November 24, 2021

      @Mark B +1 – Maybe this overtly politically correct headline seeking non-active Government would let us ALL set up Quango’s and get paid on the same basis as all their Chums.

    6. Sir Joe Soap
      November 24, 2021

      Well you can compare on a time related basis or you can compare between countries life expectancy per £ spent. We rarely hear how we are doing.

  4. DOM
    November 24, 2021

    John is either being obtuse or simply naive. I’m not sure which. Or maybe he’s acting politically since the NHS along with race are the two issues that terrify Tory MPs so they choose to skirt around the facts to deflect criticism or immunise themselves from political harm.

    The truth is simple. The NHS is a deliberate and well organised scam on the taxpayer. I know it, we all know it and every Tory MP knows it but since the issue of the NHS is all important to them politically they choose to finance this scam by abusing the taxpayer to finance their lack of moral courage rather than imposing huge reform to make the NHS ‘private sector efficient’

    I believe the Tories are so captured by Labour and their network of allies (BBC, NHS etc) that they will bankrupt the UK to insulate themselves from harm. The taxpayer is in effect financing Labour’s eventual to power and when Labour is back in power they will act as the Democrats are doing, with brutality and imposition. They will take no prisoners. And all because the Tory party refuses to do what is necessary

    1. Everhopeful
      November 24, 2021

      Possibly because the Beveridge Report 1942 lost Churchill the election in 1945.
      NHS became one of those ancient Tory shibboleths that still rule them.
      They should have disabled and disbanded the NHS at the first possible opportunity.
      “The Way to Freedom from Want” was the promise of the report.
      And it lumbered us with all this nonsense.

    2. Shirley M
      November 24, 2021

      Well said DOM. We have legalised discrimination (positive discrimination is still discrimination) and legalised animal cruelty (the religious exemption against humane slaughter). What is the point in having laws against discrimination and animal welfare laws? Why bother at all?

      1. Nottingham Lad Himself
        November 24, 2021

        There is a European Union-wide ban on such slaughter methods.

        As a member, the UK opted out of it, as did some other countries.

        1. Peter2
          November 25, 2021

          Is this ban actually being enforced?

          1. Nottingham Lad Himself
            November 25, 2021

            It is a matter for the member countries’ authorities.

            You could research, and find out whether there have been prosecutions, in countries which have not opted out like the UK did, couldn’t you?

            Personally, I think that there would indeed be a role for a centralised inspection and enforcement authority within the European Union, particularly when it had members like Tory UK, with its laissez-faire approach to e.g. sewage treatment.

          2. Peter2
            November 25, 2021

            You seemed to suggest you were an expert on the topic so I thought I might just ask you NHL
            But avoid answering if you want to.

        2. Micky Taking
          November 25, 2021

          ah ! a selective ban, like so much the individual EU countries decide do we, don’t we….

          1. Nottingham Lad Himself
            November 25, 2021

            It’s either over-centralised or it isn’t.

            Which do you prefer?

    3. Dave Andrews
      November 24, 2021

      The issue they skirt around even more is the amount of healthcare required to treat lifestyle diseases.
      I favour a workplace health insurance scheme, with companies compensated through their taxes for relieving the NHS of a burden. There would be far more emphasis on healthy living if it meant a reduction in premiums.
      Businesses want their staff fit and healthy, but currently there is little influence they can make.

      1. Mark B
        November 25, 2021


        It would not cost the government a penny yet, would do more to reduce waiting lists for minor ailments / treatments. eg Ingrowing toenails etc.

    4. Philip P.
      November 24, 2021

      The recent productivity statistics are not good, but may not tell the whole picture. A University of York study found that between 2009-2016 NHS productivity gain averaged 1.4%, outperforming productivity gain in the wider economy (0.2%). Clearly something changed after that. But it suggests the NHS model itself is not inherently doomed to poor productivity, and perhaps the problem is more the way it is currently being run.

    5. lifelogic
      November 24, 2021


    6. glen cullen
      November 24, 2021

      I believe that the Tory leadership use the feedback and exemplar of the BBC and the NHS as their yardstick to life, liberty and success

  5. Everhopeful
    November 24, 2021

    Just tried to read some totally batty article about Reset NHS. Incomprehensible.
    A “five year plan” presumably?
    And just as useless.

  6. Ian Wragg
    November 24, 2021

    The NHS us run entirely for the benefit of the staff.
    Patients are a nuisance.
    There is no real method of measuring productivity in the public sector most are just a drain on the taxpayer.

  7. Everhopeful
    November 24, 2021

    Let’s hope that the NHS can help poor Sheffield United midfielder John Fleck who collapsed on the field during a game yesterday.
    A lot of sports people (and others) seem to be collapsing at the moment.
    Don’t they?

    1. Nottingham Lad Himself
      November 25, 2021

      Sadly, they are all the time.

  8. SM
    November 24, 2021

    Seven years ago, my husband was sent to an NHS speciality hospital for a particularly invasive test to verify a speculative diagnosis. What should have been a 3 day stay stretched into 6 weeks because of the MRSA infection. He was then transported to our local NHS District General Hospital; as it was a Friday, he was given a bag full of prescribed medications to cover him for the weekend until the receiving hospital’s pharmacy opened on Monday. On arrival at the DGH, the receiving nurse confiscated ALL the medications because “we don’t allow medicines from other hospitals!!!!”. Since the pharmacy was indeed shut for the weekend, he went without until the Monday afternoon, and similar nonsense continued for the rest of his stay.

    The only part of the DGH that actually worked efficiently and in a kindly and thoughtful way was, sadly, the A&E Dept where he died two months later.

    1. SM
      November 24, 2021

      PS. Some time after my husband’s death, I wrote a polite but detailed letter about the ineptitudes to the Hospital’s Chief Executive. I never even got an acknowledgement.

      1. Micky Taking
        November 24, 2021

        someone dropped it in File 99.

  9. turboterrier
    November 24, 2021

    Sir John. Excellent post that is confirmation of what has been suggested to change the NHS.
    I have suggested on this site that as in Trusts patient base is different we need small specialised units running their operation on a self directed team basis.
    SDTs have been around in industry and commerce for decades. They do not need layers of management and quangos to tell them what to do and how. SDTs when organised and run properly by themselves will always be looking for continual improvement, it is in their interest to do so.
    So once again I suggest pilot schemes in each Trust then you have something to benchmark against to best adopt best practice. There are hundreds of retired people out here all experienced in this area of ISO 9000, you do not need to look too far locally to find people who understand the area and its people to assist in training the staff. It all hinges on whether the top team want to travel in that direction to become a real team player.

  10. acorn
    November 24, 2021

    Talking productivity. “The Department of Health and Social Care (DHSC) is due to announce that tech bodies NHSX and NHS Digital will merge into NHS England as part of a major restructuring.

    In an internal email, seen by Healthcare IT News, NHSX CEO Matthew Gould said the brands would be “retired” to accelerate the digital transformation of the NHS.”

  11. lifelogic
    November 24, 2021

    The new CEO of the NHS has already shown herself to be innumerate and is an insider quite unsuitable for the job and the foolish Heath Sec. just orders us to “just respect the NHS”. Some people working there do indeed deserve ot respect. The NHS system is appalling (has been since inception) it often treats patients with complete contempt – they are seen as a nuisance to & it not the reason it exists. It also often treats its own medical workers with total contempt too. Only about 50% of UK trained doctors stay on there they can earn more with less stress and hassle elsewhere. Junior doctors are often given insufficient specialist support, facilities or time to do their job properly/safely & then get blamed for this by the NHS managers responsible for this.

    One consultant surgeon I know retrained as a lawyer and now does medical litigation against the NHS which is far more profitable and less stressful than working for them. Another junior doctor left after 18 month sick of being treated with contempt and went of to Oxford to do a public health degree.

    Why do NHS diversity officers earn nearly thee times that of a junior doctor (who also probably has £150k of student debt plus interest to repay)?

    Real and fair competition is needed & not this communist, take what you are given (if/when you are given it or lump it mate). A dire state monopoly.

  12. PeteB
    November 24, 2021

    If you want an efficient NHS have a look at the best models elsewhere in the world. What do they do, that we don’t? How much do they spend (my suspicion is that spending is similar)? How have they removed waste? What do their staff get paid?

    And of course the key question: Why is the NHS the largest health service in the world, based on staff numbers?

    1. Mark B
      November 25, 2021

      Good idea.

      It is often said by those that have used them, that the French, German and Swiss models seem the best. Of course, there is a level at which the individual is expected to pay into. Something that is evidently missing from our system.

  13. Denis Cooper
    November 24, 2021

    Off topic, I have a short letter in today’s Irish News, as follows:

    “‘Fantastic’ trade deal”

    “Labour MP Ben Bradshaw asked the government for an official assessment of the economic damage we might suffer if the EU cancelled the present trade deal.

    (‘Labour warns against ‘damaging’ trade war with EU over protocol amid suspension pleas’ November 19.)

    Good luck with that, because a year ago I put in a freedom of information request for an official assessment of the economic value to the UK of the ‘Canada style’ free trade deal that Boris Johnson wanted, and officials in three departments all said they had no information on that.

    As they could not say then how much such a deal might be worth to us I doubt that they can say now how much we might lose if it was cancelled.

    Various alternative sources put the value of the deal to the UK at somewhere between zero and 2 per cent of GDP; perhaps Mr Bradshaw would be content to rely on the estimate from the EU Commission, near the middle at 0.75 per cent of GDP.

    Or maybe he would prefer to accept the word of the prime minister, who went on television last Christmas Eve and told us that his ‘fantastic’ trade deal was worth £660bn, which works out as about 30 per cent of GDP.”

  14. Narrow Shoulders
    November 24, 2021

    Sir John writes about the need to reduce agency workers but that genie is out of the bottle.

    Why would a nurse work full time for £26 to £30K when she or he can work four days per week for £50K with accommodation and travelling repaid? Only those with families would countenance such a choice and by the time the nurse decides to have a family, agency working is ingrained and they can take less work locally for the same take home as a full time role.

    1. SM
      November 25, 2021


  15. Old Albion
    November 24, 2021

    What NHS. Oh! you mean the English NHS. The NHS where my wife and I cannot get an appointment with our GP but are told we can have a telephone consultation !!!!
    More and more money poured into it. Worse and worse service from it.

    1. lifelogic
      November 24, 2021


    2. Micky Taking
      November 24, 2021

      The next step by the unscrupulous GP businesses will be to downsize the rarely used premises perhaps to a mobile home on a farm. A lot cheaper than paying all those business rates and council taxes.

  16. Sakara Gold
    November 24, 2021

    As is customary, Sir John has hit the nail on the head with this post – a good, quality analysis of the NHS. Unfortunately, only ~50% of NHS staff are clinically or technically qualified. The remainder organise procurement, HR, training, accountants, secretarial etc. The more the government spends on the NHS, the more financial spend data the government wants – so the more accountancy posts it needs….ad infinitum

    I would much prefer to see the additional funds spent on new specialist hospitals (on the now forgotten principle of clinical “centres of excellence”) and more GP surgeries . This would cut waiting times and give the taxpayer value for money.

  17. jerry
    November 24, 2021

    Without knowing the methodology as to how “productivity” was measured those (ONS) figures are meaningless, such naked figures can be moulded to suit what ever argument someone wants put, or any conclusion be left hanging for others to draw perhaps misinformed conclusions; set the hare running, watch the greyhounds run…

    It is very difficult to measure “productivity” in a reactive sector, for example, it is very expensive to have a cardiac ward full of underused equipment, very expensive to staff that ward too, very ‘unproductive’ but surely not having any patients is very good – should the cardiac ward close, its staff be reassigned, retrained as midwives or whatever the most acute staffing shortage is?

  18. Donna
    November 24, 2021

    We won’t get additional beds because the NHS CEO’s priority is to grow the bureaucracy ….. like every other “public service.”

    Their current focus is on recruiting Equality and Diversity Managers who, in turn, will prioritise finding “evidence” that their Trust is riddled with WAYCISM and TRANSPHOBIA (their current issues of choice) which will require the recruitment of even more administrators to monitor the thoughts of the other staff and the few patients who are allowed through the doors.

    Meanwhile, anyone with a £thousands to spare who needs elective (non-life threatening) surgery will start to go private because otherwise they will face a 3 year+ wait, possibly in severe, disabling, pain. And slowly, slowly, healthcare in the UK will go the way dentistry did. In 1970 there were hardly any private dentists. They started appearing in the ’80s and now it is very difficult to find an NHS dentist. People choose to pay for superior treatment or because they have no choice but to pay ….. or they don’t go to the dentist at all.

    And STILL what remains of the NHS will be top-heavy with bureaucrats because it isn’t a health SERVICE; it’s a job creation scheme for left-wing healthcare providers.

  19. Mike Wilson
    November 24, 2021

    If you increase the amount of goods or service each individual worker can produce you have a more efficient economy and pay can rise to reflect the boost to output.


    If you produce the same amount of goods or services that each worker produces in LESS TIME, each worker has more leisure time and an effective pay rise.

    Mr. Redwood, will you ever stop your obsession with growth and endlessly increasing consumption. Your proposition is basically flawed. If every worker produces more goods and services you need more people to consume them. Oh, wait, that is why your government keeps allowing the population to go up.

    Reply No, you have more people who can afford to consume them without extra people coming in.

  20. miami.mode
    November 24, 2021

    …………The Health Secretary needs to challenge the NHS CEO more…………….

    A recent topic asked Who Is In Charge and by the above comment it certainly sounds as though it is not the Health Secretary. This suggests that the government has no clear ideas on what it wants and is therefore destined to fail.

    1. Mark B
      November 25, 2021

      As the saying goes : “When you fail to plan, you end up planning for failure.”

  21. Nig l
    November 24, 2021

    And in other news the wind is not blowing so coal fired power stations are being increasingly used.

    This exposes the figures, based on expected windy days, used to support our drive to net zero as vastly inflated.

    What other ‘lies’ are the Government using to mislead the public in its push for Green?

  22. Micky Taking
    November 24, 2021

    Thank you for raising the efficiency concerns, specifically on the NHS. Most people we know have become more and more cynical of the NHS in recent years prior to the pandemic. A few that praised the (dis)organisation seem to have moved, admitting problems with its performance and often quoting administrative errors. People watch the eye-watering sums being granted by Government and conclude a form of sweeping under the carpet. Money doesn’t solve what is going wrong.

  23. BOF
    November 24, 2021

    The hospitals were not even allowed to use Ivermectin to treat Corona virus, a safe drug which has been in use for 40 years! It may have kept many out of ICU and contributed to efficiency. It now emerges that in a number of countries in Africa where it is routinely used for other reasons, it has resulted in a much lower mortality rate for Corona patients.

    Perhaps this Government and the scientists would like to offer an explanation and tell us who did benefit.

    1. Paul Cuthbertson
      November 27, 2021

      Ivermectin is not a money maker. Your health is irrelevant. Follow the money.

  24. Bryan Harris
    November 24, 2021

    Rationality and good business sense should demand that “Working smarter” should be done first rather than just throwing money in the general direction and hoping something will get better.

    Once again, we see inept government policy putting the cart in front of the horse.

    There is no rational approach to the NHS any more, it has become a sacred cow that must be allowed to consume ever more resources.

  25. alan jutson
    November 24, 2021

    The NHS is not efficient John because we have too many people with their fingers in the pie, all working to a different recipe, using different utensils and ingredients.
    Thus they tend to work to the lowest common denominator.
    We have some absolutely brilliant people in the NHS, but we also have far too many that are below average in performance and attitude.
    Unfortunately the bar has been set low with those who are below average in mind.

  26. glen cullen
    November 24, 2021

    Productivity and the NHS I hear you say –
    They can’t even distinguish between those who have sadly died following confirmation of having a covid infection within 28 days by other means.
    If they and the government can’t present the simplest of statistics correctly then we must question all government statistics.

  27. ukretired123
    November 24, 2021

    Boris fired the guy who knows just how to “Work Smarter and Better” which the country desperately now needs urgently. Boris can then promote himself elsewhere…..

    1. Micky Taking
      November 25, 2021

      was that Johnson, or the ‘err indoors’ ?

  28. Original Richard
    November 24, 2021

    I would like the Government to ask each NHS Trust to publish a completed Excel file with the headings : Job Title/Number of Personnel/Medical Qualification/Salary with all employees and consultants included.

    1. Mark B
      November 25, 2021


      What those Diversity Officers earn and their qualifications should make good reading 😉

  29. turboterrier
    November 24, 2021

    We all know that rocket science its not.
    If you have leaders with vision and drive they make things happen whether they be leading a country or our health service. Sadly we have neither.
    Aided and abetted by a civil service not fit for purpose. Time to get the long knives out of storage.

  30. Lester_Cynic
    November 24, 2021

    Slightly off topic

    I expect that everyone has seen the totally cringeworthy performance by our dear leader at the CBI bash?

    Back on topic…. I agree with all the previous comments about the NHS, it will never be reformed because it’s too big to tackle now with all the pen pushers and a 6 million waiting list, I have concerns about a problem that I have and I’ve made an appointment to go privately to see a specialist in 10 days, worth every penny

  31. Nota#
    November 24, 2021

    “We are still waiting for the plans to spend the extra money for the waiting list reduction and the manpower plans. ”

    How many years now?

    It will never happen each criticism is met with ‘we need more money’ – The management is not accountable to the Customer, they are just a spending machine. In the last few days we have read elsewhere that the recruitment is under pressure as management feels the need to enhance their ‘diversity’ departments so as to have the right people in place to select candidates for elsewhere. That’s before they go looking for frontline staff and for that they need more money.

    So neither accountable or responsible, the front facing staff take the wrap for the backroom empire builders.

    Time to put it all on a Commercial footing paid for by the Insurance Contributions the taxpayer is not unreasonably forced to pay. The let the Customer take their Insurance payouts to were they get the best service.

    Common sense

  32. agricola
    November 24, 2021

    Today you focus on the NHS. As far as their administration is concerned they are only part of the massive damp cloth generally known as the Civil Service who infect just about every government ministry they work in. They are largely technically ignorant, hence the string of technical disasters they have presided over in my lifetime. They are not stupid people, just totally unsuited in this scientific engineering age to be responsible for swathes of our activity in such areas, which is just about everything we do these days. Being risk averse and suffering group think they impose themselves on the business world which is just the opposite.

    To his credit Boris must have realised the limitations of the Civil Service when it came to appointing someone to oversee our vaccination creation and application programme. It worked and should be a lesson to all of you in Westminster that our current system has failed us for far too long. You rectify it by defining the sort of educational and working background from which civil servants are recruited. They need industrial experience to the age of thirty before being let anywhere near government administration. One outstanding example from history was Lord Beaverbrook. You also need to contract in expertise at all career ages. Do it and you will end lethargy and failure, which are the hallmarks of our Civil Service.

  33. Footprint
    November 24, 2021

    Why bother to ask Sir John, when you should know the first answer as already pointed out in another comment already on here, the NHS is a public body, you are not comparing the performance of two like industries.
    If say, you picked an ` efficiently, low cost (comparitively) and well performing` European country for instance and compared more like with like (or failure with success condemnation/appreciation) you might get somewhere.

    In fact I might be highly suspicious of this current efficiency quest when if I am correct previous ones resulted in the wholesale loss of local cottage hospital services and what was more important the loss of hospital BEDS due mostly to bed blockers where there were no or little facilities for their care in the community.
    This mistaken policy was exemplified by the panic provision of Nightingale hospitals in the present `nonepidemic manufactured crisis` and their apparent subsequent hasty abandonment due to staffing problems.

    But supervening all this (as I admit I believe Sir John, you have pointed this out before) is the problem of the yearly nett incremation of a new population of immigrants (legal plus those who cross the chanel either in dinghies or the back of lorries) an incremation for so many years, i cannot remember, but certainly replacing a required population for the like of a town the size of Leicester or Coventry.
    The Nation is beyond FULL UP, should we wonder that so many services besides the NHS are in or near crisis level and most of it is due to Government or their Civil Service masters to appreciate that everybody cannot `shuggle up` and make do forever.

    Oh and it doesn`t help, that the Government has ceded its authority and the NHS is now apparently issuing the orders and running the country too

  34. paul
    November 24, 2021

    They have to have somewhere to put all the dead brains coming out of uni.

  35. Nig l
    November 24, 2021

    We saw from the absolute shredding of the Civil Service and the NHS, that Kate Bingham gave in the Times that the institutions are not fit for the 21st century and she has the track record to be believed.

    Only invoking ‘war time’ regulations enabled the vaccine roll out to be successful and we saw subsequently when the booster jab programme went back to the ‘blob’ how quickly it subsided having to be jerked back into action by public outrage.

    She highlights the avoidance of blame culture and we see that, being in total denial about their management of the pandemic.

    So with Ministers complicit, hiding, avoiding the issue my question to Sir JR is ‘why does he think anything will change’? Because I guess most contributors and the wider public think differently.

  36. Nig l
    November 24, 2021

    Re organisations. The late Sir Brian Bender’s advice to PMs if asked. Don’t do it unless there is a real case for it.

    Well Sir JR. Is there/have you seen one/ has the Secretary of State?

  37. a-tracy
    November 24, 2021

    What is the desired productivity ratio?

    £10 per hour + Employers NI and Nest 13.8 and 3% + holiday pay + SSP provision + SSP Hol pay. What turnover should the company expect for every hour worked to be considered productive in the UK?

  38. X-Tory
    November 24, 2021

    Off-topic Sir John, but I promise* you will like this. The Britain-hating media, fuelled by the Britain-hating Left, do nothing but denigrate this country, so sometimes it is instructive to see what other – neutral – observers think of us. The influential Japanese ‘Mori Memorial Foundation’ (an institute devoted to improving urban development and living) conducts an annual evaluation that “ranks the major cities of the world according to their “magnetism,” or their comprehensive power to attract people, capital, and enterprises from around the world.” And guess which city is the world’s number 1? LONDON. For the TENTH year in a row!!!

    For more details, the report can be found here:

    The Japanese media obviously reported this, and were proud that Tokyo came third on the list, but over here the fact that London came top has, of course, been completely ignored. (* Have I kept my promise?)

  39. Newmania
    November 24, 2021

    One of the things that had to be on the “to do” list was a general reform of the Public sector which, really should be the on going task of all Parties . Various changes have contributed to a better picture in schools
    (without expecting perfection ), the health service has slipped out of control
    I do not believe it is either left or right wing for the Public sector to provide value and it is patently absurd to let them “mark their own work”.
    An organisation which employs 1.4 million staff cannot exist without having its own agenda and its own power. Controlling has political costs of course.
    While the country has been preoccupied in making itself poorer and more absurd the grass has grown , Covid was a grim coincidental push in the wrong direction and now unaffordable costs are a threat to our money and health .
    There seems little chance of the Populists getting their hands dirty and I fear we will, have to wait until the consequences of this long era of stupidity can no longer be hidden for people to demand competence.
    Twas ever thus .. its just tnat it used to be the Labour Party who made the problems – Socialist Brexit Party

  40. Andy
    November 24, 2021

    Improved productivity is a good thing – including in the NHS. But the Tories consistently maintain policies which go against this.

    Let me give examples. We should be able to book GP appointments by app or online. What a complete waste of time it is doing it on the phone. But there’s a problem. To build and maintain systems of this complexity you need computer experts. And computer experts cost money. But Tories object to spending NHS money on anyone who is not frontline medical staff. The computer experts could make your experience NHS better. Your government won’t countenance it because the IT people aren’t nurses.

    If a GP refers you, we are into the realm of old fashioned postie delivered letters. Why? What about email. These letters invariably create an appointment you can’t make. We need to be able to make referral appointments immediately after seeing a GP. We don’t want a nurse to do this. We need an administrator. But we can’t have administrators in the NHS because they are bureaucrats. And, according to the Tories, all bureaucrats are bad. (Except unelected clown Lord Frost).

    The Tories also tell us what a scandal it is that foreigners don’t pay for NHS treatment. This is actually untrue. They DO pay for NHS treatment it’s just that swathes of the NHS are not geared up for taking payments. Why would they be? Most of us don’t pay at the point of delivery. An American friend of mine who had an accident in central London was asked for his credit card before he was treated in an NHS hospital. The big hospitals in London are geared up for payments. But if you want the rest of the NHS to charge you need people to take and process the payments. A nurse shouldn’t double as an invoice clerk or credit controller.

    The reason NHS can sometimes be frustrating is precisely because the Tories have waged war on the back room people we need to make it work. Tesco is not just a success because of the shop workers. It needs an army behind the scenes to make it all happen.

    This thread will again misdiagnose the problem. You will all rage against the very people who can make the NHS work better.

    Reply My local surgery invited me for vaccination via text. The NHS has spent billions on computers.

    1. a-tracy
      November 25, 2021

      Andy, are you even in the UK? You can book appointments by app and online ‘MyGP’. You can e-consult. Where are you in the UK where you don’t think you can do this? Records are in the ‘Spine’ it cost a fortune to set up. It just needs a tweek so that you can read your own record and see the footprints of who has accessed it and when.

      I had a text to book my jab.

    2. Micky Taking
      November 25, 2021

      the texts can, and often are generated by selection listing on databases, been done for years.
      Who needs people typing them all day?

    3. Paul Cuthbertson
      November 27, 2021

      Reply to reply – and did you have the jab in the arm!!!!

  41. Andy
    November 24, 2021

    Talking of productivity – how do we measure the productivity of an MP? Is it hours worked? Or constituency letters answered? Or number of votes in Parliament?

    Following the Tory sleaze row many MPs came forward to say they work 70 hours a week or more. I believe them. I think most of our MPs are hardworking.

    But there are clearly some who don’t work hard for their constituents. Particularly those MPs from safe seats who’ve been in Parliament for years. They often have second, third and even fourth jobs. They clearly are spending less time working on behalf of their constituents than others.

    Perhaps their taxpayer funded salary should be reduced accordingly?

    Reply Many of the Conservatives who have been in Parliament for many years are particularly assiduous contributors to debates and committees as well as being good at following up constituency issues.

    1. Micky Taking
      November 25, 2021

      Andy – you would have been better off challenging Senior Civil Servants, you just got put in your place by an excellent MP. You don’t have to agree all the time, but don’t challenge effort please !

  42. Doctor John
    November 24, 2021

    The NHS has a lot of good people, doctors, nurses, physios, etc.
    However the bureaucratic administrators are appalling and this is what lets the NHS down. Reform the admisistrators and let the medics do their job properly.

  43. forthurst
    November 24, 2021

    There are too many administrators at too many levels of the NHS. Do not expect civil servants who have no useful skills being Arts graduates to make themselves redundant and join the real world of work. Hospitals should be run by medics not people not clever enough to qualify as doctors. GPs do not need organising and constantly told what they should be doing if they are properly trained and qualified in this country either.

    Arts graduates are no use to anybody; get rid of the lot otherwise we will continue to fall behind countries for whom the mystique of learning irrelevant rubbish at university and then mismanaging the governance of the country does not exist.

  44. Ed M
    November 24, 2021

    Why can’t the government do more to encourage initiatives to get people to eat more healthily and take more exercise. This would drastically reduce NHS bills (both for physical and mental health) and make people are more productive and happy in general with huge knock-on efforts on our country in general.

    The reality is that lots of working class people are buying and eating sh*t (crisps, sweets, processed food etc). I don’t want to take choice away from people. But working class people could eat just as cheaply and well and delicious food by eating more things like brown rice, porridge, bit of green veg, cheap apples, nuts, and so on. And then taking more exercise. And it’s a vicious circle. The more unhealthy they feel from eating sh*t, the more sh*t they eat, and the more fags they smoke, and the more booze they drink. Costing the NHS billions and billions. And greatly reducing productivity.

    1. Ed M
      November 24, 2021

      In the old days, the working class were much poorer. But the majority of working classes today can easily afford to buy healthy food (bag of brown rice, for example, costs £3 and provides so much nourishment and lasts for days – and where they save with brown rice, they they can buy a nice bit of chicken / meat and veg and apples and so on. Balanced diet. And they can save loads of money with porridge and then spend their saved money on a nice bottle of wine etc .. Not rocket science. But sadly millions are buying sh*t and it’s all a vicious circle. And I talk as someone who used to smoke fags, drink a few beers, and eat lots of pizza, crisps and choc. I don’t miss any of that sh*t at all. And feel so much better for more healthy diet. Plus more energy. And I enjoy much more ‘treats’ when I do have them and indulge from time to time. Lastly, even people’s s-x lives are greatly improved when they eat more healthily. So everyone’s a winner: tax payers (hugely reduced NHS costs), employers with more productive work force, husbands and wives having much better s-x, people generally feeling much better and happier overall.

  45. Iain Gill
    November 24, 2021

    problem is the NHS is not paid on results, or patient satisfaction.

    its a take it or leave it, ration, and allocation, bureaucracy knows best model.

    there are many disincentives to doing the right thing. and lots of resources are allocated according to fashions, and identity politics reasons.

    for instance the reason mass testing of PSA levels in men is not done is largely because if they did they would have to do a lot more prostate biopsies, and a lot more earlier treatment of prostate cancer. their workload would go up significantly, and so the bureaucracy avoids identifying the people it could save and offer many decades longer of happy life, and leaves their prostate cancer to be detected too late for any useful treatment and in doing so reduces the net amount of work the NHS has to deliver. and of course its men so none of the powerful lobby groups push for improvements.

    this stuff needs radical kick up the bum of the NHS bureaucracy.

    1. NotA#
      November 24, 2021

      @Iain Gill +1. It is serving it’s administrator s not the customer. It’s time to separate the compolsary taxpayer funded National Insurance scheme from the National Health Service. Let the money follow the service.

    2. Micky Taking
      November 25, 2021

      You ignore the fact that PSA is not a very accurate diagnosis tool for possible cancer. As I understand it GPs were typically using PSA as a help when presented with a complaint of waterworks issues. Over 15 years ago I presented, had a test which the GP explained ‘might’ suggest a problem, a score of over 4 might indicate. Over a few years my score went through the teens, I had physical examination, followed by 2 types of biopsy, a low score Gleason test, and continue a monitoring test every 6 months.
      The PSA also brings with it an unjustified fear of prostate cancer and a very shortened lifespan. Many further procedures might follow – a problem for the NHS, the man affected and his family. In many, many cases it will be an enlarged prostate, not progressive cancer.

      1. Paul Cuthbertson
        November 25, 2021

        The PCR test is not reliable either as stated by the inventor who died mysteriously following his statement.

      2. Iain gill
        November 25, 2021

        I know the pros and cons of the PSA test very well.

        It produces a shortlist of people to consider for biopsy, and biopsy produces a much higher diagnosis probability.

        Doing both in larger numbers is the only way of reducing prostate cancer deaths.

        We do far less tests than many other countries, and hence our results are far worse.

        Your analysis is just the lazy mandarins excuse.

        Indeed it is worse because the NHS will do PSA Tests on patient demand, so early diagnosis has become much more likely among men educated in this stuff. So class based access at its worst.

  46. NotA#
    November 24, 2021

    What comes to mind with every review is the outcome is always based on bigger is better, consolidate into bigger empire’s are even better still.

    More advisors are then needed to shape efficienty, ensure diversity, ensure that there is training to be on message.

    In effect the bigger and the more remote from the customer the better for these new empire’s to keep growing.

    It’s the way Government’s work, it’s the way the civil service works, so those involved are able to relate and encourage.

    This (health) is a customer first service, those closest to the recipient can always do a better and more efficient job. They can react and respond with more flexibility. That is also the point, we are all different, each area/region has different requirements that are always changing.

    Government in this respect have lost who they serve they have more interest in a ‘mirror me’ view of the world.

  47. Lindsay McDougall
    November 25, 2021

    The first question that the Secretary of State needs to ask is “Why appoint 42 regional health and social care supremos at £200000+ per annum each?” It looks like the return of Strategic Health Boards by the back door. It’s known as a diseconomy of scale.

    1. Nota#
      November 25, 2021

      @Lindsay McDougall Its called a taxpayer give away. The majority of the care system is in ‘private’ hands, and is not responsible for the service provided or accountable to the taxpayer for that service. Then again the parts that are or should be seen as the State sector enjoy the same relaxed attitude of being given taxpayer money yet not being responsible or accountable for it

  48. Paul Cuthbertson
    November 25, 2021

    Smarter and better – hints of the WEF jargon here.

  49. a-tracy
    November 26, 2021

    John, can you please get the productivity targets for us? What is a productive company for this governments statistics purposes? Why aren’t businesses ever told?

    Also, government run organisations harm our productivity, roadworks taking years, sections closed for months on end with no work done on them slowing down trade – increasing working driving hours reduces their productivity, not hitting delivery book in slots reduces warehouse productivity, not hitting return bookings reduces productivity. There are more hold-ups on smart motorways than ever in history, when there was a hard-shoulders, cars would get pushed to the side and then normal traffic resumed.

    When the NHS aren’t seeing people then you lose employees for months on end, people are getting misdiagnosed and end up more poorly because the drugs they were given were incorrect, when train services strike then workers can’t get to work easily and on. Save us from nationalisation before it’s too late.

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