I have often called for an NHS manpower plan, and have been urging Ministers to agree a way forward over employment with senior NHS managers. The agenda for any talks between representatives of the 33,000 NHS managers and top Ministers should include:
1. How many medical and support staff will it take to get waiting lists down?
2. What will it take to fill existing vacancies?
3. Given the urgent need to put in more beds to hospitals, what extra staffing is needed for extra beds?
4. Are current arrangements for choice of shifts and timing of work sufficiently flexible?
5. Doctors retire early with some saying it is pension tax rules. Can these be eased?
6. The tax system hits people when they go over ÂŁ100,000 a year where many doctors are. Can the anomalous 60% rate be reduced/ tapered better?
7.Are nurses correctly graded for the band based pay system?
8. How much use is made of promotions to boost the pay of good committed staff?
9. Is enough being done to train more future nurses and doctors?
10. Are there procedures and advice that can be handled by suitably trained and certified people who do not have full doctors qualification but are expert in the permitted field?
11 What will the savings be from substituting permanent employees for Agency staff?
12 How can quality and productivity overall be improved?
December 27, 2022
Good Morning, Sir John.
The Together campaign has a a very sensible answer to your second question. It is in their open letter delivered to Steve Barclay, Secretary of State for Health and Social Care, in early December, parts of which I copy here:
‘Forcing out approx. 40,000 social care workers for declining the Covid jab was not just unethical, but disastrous for the care sector and those it supports . . .
‘Throughout most of 2021 there was clear evidence that Covid jabs did not prevent transmission and the Department of Health and Social Care warned Sajid Javid that his âmandateâ policy would result in upwards of 40,000 care staff leaving the sector. Unfortunately, on 11 November 2021, workers who had not already been forced out were sacked. Many lost not only their jobs, but also their pensions.
‘Without a functioning social care system, the NHS will collapse. In the NHS, we have ever-increasing waiting lists for operations and longer waits in A&E due to the lack of beds. This in turn leads to longer ambulance waits. There are an estimated 13,000 patients in hospital beds medically fit to be discharged but with no care package due to the lack of care workers and fewer care home beds. This situation is unsustainable and unacceptable. Lives are at risk.
‘Please do the right thing: Apologise, Reinstate, Compensate.’
December 27, 2022
+1 Mary M. And then there were the 80,000 staff that left the NHS before the threat of the clot shot was reluctantly abandoned by Javid.
December 27, 2022
NHS in world top quartile for money spent bottom quartile for health outcome. Says it all, badly organised and managed.
December 27, 2022
+1
December 27, 2022
Dear Sir John,
You have the right points but keep in mind that the time lag for many adjustments for doctors to take effect is 15 or so years. There is a proposal, predictably opposed by the medical establishment, for medical apprenticeships, which could get some junior hands to the pumps in a few years, but I wonât hold my breath.
BW Sebastian
One, relatively modest factor is reducing the number of doctors who retire early. Working 69hrs a week, evenings and weekends gets progressively more onerous as one ages. It used to be common for hospital consultants to reiterate at sixty draw their pension and then come back and work half time with little loss of income. I did so in 2020, then the NHS promptly banned the practice. Just consider the number of doctors planning to retire in the next five years, delaying this would have an immediate effect.
December 27, 2022
+++++ many
I honestly was not aware that they actually went through with the sackings.
Even knowing the dreadful depths of insanity and cold-blooded NASTINESS of govt.s I am surprised, appalled and scared beyond reason.
Were we all secretly transported to another universe in 2019?
December 27, 2022
The authoritarians running the country aren’t big enough to admit (a) they were wrong (b) apologise and (c) offer reinstatement and compensation.
One of the very few plus-points over the last 6 months of utter chaos and the LibCON coup is the fact that the Authoritarian Javid is quitting Parliament (before he’s sacked). We just have to hope he doesn’t get shunted to the House of Frauds before Starmer abolishes it.
December 27, 2022
Govt/Hunt appointed former Labour minister Patricia Hewittâs to sort out Huntâs mess. I say Hunt because he had the job the longest, six years, failed the nation, wants to copy Chinaâs WHO approach for covid and control of world health management. Hunt now promoted as chancellor. What could go wrong!
I cannot see any of JRâs points considered let alone acted upon. Hunt did not even sort out health tourism, as usual made a lot of false promises to appease the public then dropped it at English taxpayersâ expense.
Who is in charge? Hewitt or Barclay in name only?
December 27, 2022
Indeed Boris and Sunak got all the big things wrong- the lockdowns, HS2, test and trace, the net harm & rather ineffective vaccines, the money printing currency debasement causing the current inflation, net zero, the failure to control the borders. So once they started apologising!
King Charles too got everything wrong in his rather political King’s Speech. He praised the 20% who work in the state sector (clearly many decent people do work for it) but the people who really have been robbed and cheated are the 80% in the private sector now paying the highest taxes for 70+ years but who received generally appalling and still declining public services may dying while they wait for procedures, test or ambulances.
He seem to want to be a defender of irrational belief systems and religions. Be this the traditional ones, quack medicines, climate alarmism/net zero, talking to plants… Still it seems he has made a private donation to a fuel poverty charity perhaps from the ÂŁbillions he makes from renewables. I suppose that might help 1 millionth of the people suffering from the rip off, rigged energy problem created by the climate alarmist/net zero religion that Charles so supports (but not for him just for the plebs off course).
The 80% are also hit hugely by the three royal bank holiday this year and next as they lose production, have to pay wages and this have to pay extra taxes to the state sector for “services” largely not provided.
December 27, 2022
Urging the Govt to do something sensible involves a process that seems like holding on and leaving a message at a remote call centre and hoping the Chief Executive might hear it or would ever pay any attention, let alone act.
December 27, 2022
Still even under King Charles a royal family is far better than any alternative. Let us hope Kate Middleton has lifted the IQ in the Royal lineage a little. But I suppose we will have some 40+ years to wait to find out so likely to be rather too late for me. Just stay out of politics King Charles especially when you are so totally deluded and hypocritical especially over net zero and the bloated state sector.
December 27, 2022
Absolute madness. My sister felt obliged to have the jab against her wishes. She works in the care sector with dementia patients. They are permanently understaffed..
December 27, 2022
probably the awful pay rate, not the jab? If the owners can get away with it, they will!
Sir John might know a ‘home’ quite close to Wokingham Centre, recently respite started for a friend’s other half. ÂŁ2,000 a week, I kid you not ….that rate then applies if staying.
Daylight robbery – how else can you describe it?
Sir John will have my email address – I will provide the Care place name if he wants to follow up.
December 27, 2022
On minimum wage and NO sick pay.
December 27, 2022
Indeed especially as it is clear that, for the young especially (and those who had already had covid) the vaccines did more harm the good and these people were never at any serious risk. Gross negligence and incompetence in my book. I personally know of two 20ish people who now have irregular heart beat issue that came on after the vaccines and booster. That is perhaps 10% of the friends I have that I would know about! How extensive is this vaccine damage?
December 27, 2022
+1 Mary M. Especially that last para, wouldn’t it be brilliant if we had politicians that could “… do the right thing: Apologise, Reinstate, Compensate.â”
December 27, 2022
Good morning.
All very good questions Sir John but not only do you have 33,000 managers you have all their support staff as well. So what you are looking at just to manage the NHS is an admin that is roughly the size if the British Army. An army that is shrinking whilst the NHS Management is growing.
Too many Chiefs and not enough (workers Ed)it seems.
December 27, 2022
Bingo!
December 27, 2022
+1Mark,
Plus tanslators, equality diversity Marxist nonsense, life experience non jobs and a host of bean counters.
Undoubtedly this coming year councils will want to get on Huntâs bandwagon and tax us again and again for exactly the same things, social care, flood defence etc etc.
December 27, 2022
Agree. Far too much money is spent on non productive staff and general waste
instead of on front line workers and the necessary equipment to fulfil the NHS
core activity of treating patients. Any normal business not relying on ever increasing
taxpayer support would be bankrupt by now.
December 27, 2022
When will procurement be sorted out? It only wastes billions!
December 27, 2022
The head of the NHS has gone into hiding. No one is incharge of this leviathan.
It’s a bottomless money pit and wants scrapping so we can start again.
Less gender reassignment and more hip operations.
Less diversity and inclusion staff and more nurses.
More uk trained front line staff and less foreigners sending money home.
That’s just a start.
December 27, 2022
When the partygate scandal broke, the pictures were all redacted so nobody was recognisable except the target: the Prime Minister.
Now the same thing. The media and the Unions have one easy target: the government. And the real perps are back home in Surrey taking their dogs out for a walk before dinner.
It is time the magnificent 33,000 did the decent thing and supported their management instead of dobbing in poor old Steve Barclay (our local and very good MP).
December 28, 2022
Isnât Barclay one of the few Brexit MPs? Donât you think thats why he was given this role at this time? Why wasnât Hunt put back in charge of the NHS if he was so good and experienced at it! Because heâs certainly screwing up the treasury.
December 27, 2022
Perhaps another question to be asked is does the NHS need all the diversity and net zero managers on extortionate wages? Overall have they got too many managers? What exactly are these managers bringing to the table? Could the NHS do without them?
December 27, 2022
I have long thought that it is time to appoint a highly experienced business manager authorised to call for the terms of reference and job spec of each and every middle and above NHS managers to see if their positions are actually essential to the provision of medical services at the front line.
If it cannot be proven that they are essential they should be laid off – it would be cheaper to do that, despite the upfront cost involved, to provide future savings which could fund more doctors and nurses.
December 27, 2022
Your opening statement says it all 33000 managers. Crazy man crazy.
How many actually bring and add real value to the organisation?
Answers on a fag packet please.
December 27, 2022
(11) needs addressing by imposing maximum limits on the amounts that trusts can pay agencies. I’ve no problem with a proportion of the savings being used to increase the pay of salaried staff.
December 27, 2022
When Sarah Vine writes in the Mail that her Dad in Italy is getting better treatment than he would here in UK, and when Jeremy Clarke in the Spectator tells of his very sympathetic and efficient treatment for cancer in France, where I too needed to doctor just last year, then we can see how dreadful our own very expensive and uncaring service has become.
I do not think, Sir John, that your questions go nearly far enough. Not nearly far enough.
We need some serious thought and some serious rethinking with a little bit of risk involved maybe.
During covid, my treatment cost me ÂŁ3,000 for a morning’s surgery. Worth every single penny.
December 27, 2022
Yes, a tremendous opportunity lost by the Conservatives in government to commission a truly independent comparable review of health structures, financing and health outcomes in other countries where health outcomes are better than in the UK. It would have been easy, with appropriate terms of reference, to face down the inevitable Labour accusations about âprivatising the NHSâ. But no, like so many other areas of policy, itâs been put in the too difficult box and left for future governments to muddle with.
December 27, 2022
Darn, you beat me to it! Yep – such a review must take place. The Conservatives’, on the other hand, have focussed on big, expensive reorganisations.
December 27, 2022
The concerns over the waste of budgets in Wales is the equivalent to over 3000 nurses pay.
Got to be very brave or silly that only this has happened in one small part of the Service.
December 27, 2022
I don’t think it’s waste in N Wales they should worry about but fraud of ÂŁ122m. It’s being investigated. Receipts and invoices found for things never ordered etc.
December 27, 2022
Doctors retire early. Nurses retire early. They must feel they have enough pension without working more years. Maybe the generous pensions are backfiring and causing loss of staff. Also, I am trying to remember if we had a shortage of nurses before Blair introduced compulsory degrees for nurses. Any job that requires a degree is also going to bring expectations of high pay and quick promotion. It would explain why some nurses are striking.
December 27, 2022
When Doctors have been paid over ÂŁ100k for many years, and their pension pot is over ÂŁ1m, of course they think ‘why not retire?’. So would I and millions of humble workers still doing the job face-to-face.
December 27, 2022
Which is the whole point of my post. Thank you.
December 27, 2022
I’m happy to emphasise the point if it helps!
December 27, 2022
To address the first point about reducing waiting lists:
as long as innovative medical procedures and pharmaceutical products are developed, there will be an inevitable growth in demand; many of those with hitherto incurable and fatal problems now survive (but may well continue to need much care), and the newborn with such issues are kept alive at birth and may well require life-long medical care.
The NHS was not devised to deal with such a huge growth in demand, and our modern ‘situation’ requires not only managerial and economic re-planning but also very considerable ethical consideration.
December 27, 2022
+100
No expert at all but from what I remember families used to take responsibility for many situations.
The family has been largely destroyed by/with/from the interfering over mighty State.
The NHS greedily subsumed and regulated every branch of medicine, even outlawing some.
And now it canât copeâŠ.
December 27, 2022
SM, not only was the NHS designed for just basic healthcare, but it was a temporary measure (like income tax!). It was intended to bring the working class up to a certain level of good health where they could look after themselves.
December 27, 2022
It may be better to start with a NHS Management Plan.
Who are the 33,000 ? What do they do , purpose, and cost.
December 27, 2022
Yes lets employ another 2000 highly paid ‘mandarins’ to produce another master plan after 2 or 3 years consultations….sounding familiar?
December 27, 2022
Turkeys don’t vote for Christmas.
NHS Managers aren’t going to conclude that there are too many NHS Managers and what they are doing is unnecessary (at best) and possibly counter-productive.
As I pointed out a week or so ago, the NHS needs a “Gorbachev.” Someone from the inside who is given the top job, is prepared to admit that the structure has failed, and who will dismantle it. But the Government keeps appointing “Don’t Rock the Boat” insiders like the invisible and utterly useless Amanda Pritchard.
December 27, 2022
What happened to the GPS who treated every ailment?
Syringed ears, took blood pressure, lanced boils, gave injections, attended to pregnancies etc etc?
Many GPS worked alone and bar operations fulfilled every function.
Many also had a dispensary on the premises.
I very much doubt if outcomes were ever improved by chucking money at all the expensive extras!
December 27, 2022
There are some very rich recruitment agents out there.
Housing dingy migrants has topped ÂŁ10 million every day. Thatâs ÂŁ3.7 billion every year.
This Government is destroying our country.
December 27, 2022
âDingy migrantsâ? Or âDinghy migrantsâ?
Freudian slip or autocorrect?
December 27, 2022
Yes, and it’s doing it deliberately. You can’t Build Back Better if you haven’t first destroyed everything.
December 27, 2022
Apparently Theresa May has said that the Modern Slavery Act must not be changed to make it harder to claim ‘asylum’ in this country. Bearing in mind the disastrous nature of her Premiership, Sunak would be well advised to listen to what she says and then do the opposite.
December 27, 2022
May did appalling damage in trying to kill a real Brexit, her net zero bill, the modern slavery act, open door immigration regardless of skills and helping to kill her party. Why did this juvenile LibDim ever join the Conservative Party?
Better chance a winning a nice seat I suppose by pretending to be a Conservative rather than as a green crap pushing socialist LibDem. Had Gove not stabbed Boris or even had Boris not caved when stabbed we would never have had to suffer this appalling Woman. Party members would never have chosen her.
December 27, 2022
She needs to remember she was a failed PM very quickly. The voters soon saw past the slogan Brexit Means Brexit.
December 27, 2022
Doctors need to be doing medicine
Nurses nursing
And admin staff doing necessary admin
Currently Doctors and nurses spend inordinate amounts of time doing admin mandated by managers who have to find work to justify their own existence.
December 27, 2022
If the Government asks the 33,000 NHS Managers to deliver a Manpower Plan (something any decent Head of HR would have done anyway) we all know what the response will be:
“We will first have to create a “Department for Manpower Planning” in every Trust. Each will require a Director on ÂŁ250,000; two Managers on ÂŁ150,000 each; 4 Deputy Managers on ÂŁ100,000 each; 8 Administrators on ÂŁ40,000 each and someone to make the coffee on ÂŁ25,000. Obviously recruitment must be in accordance with our Diversity Agenda, so it might take some time to find people with suitable characteristics AND the required level of expertise/experience but I’m sure there must be quite a lot of black, one-legged, trans-something-or-others out there for the lead roles in each Trust. We’ll just have to keep looking until we find them.
When we’ve done that, we’ll let you know and we can meet again to discuss the Terms of Reference. However, we first need another ÂŁ5 billion to cover the start-up costs. Let us know when you’ve given us the money.”
December 27, 2022
But Donna, you forgot to mention the necessary creation of a separate Advisory Management Committee to advise the Dept for PERSONpower Planning in each Trust!
December 27, 2022
+1
December 27, 2022
As a slight aside I know of two retired doctors. Both are in their fifties. They both live in houses worth close to ÂŁ2 million and appear to me to be loaded. The two of them are âyoung fiftiesâ – fit, active and youthful looking.
I constantly hear in the media about how poorly doctors are paid, how stressful it is etc. but, as well as the example of the two (above) that I know well, the ones at my GP practice work a 3 day week and rarely see patients in person.
The NHS has become a farce and should be dismantled.
December 27, 2022
A new doctor starting now cannot really live on the NHS pay level and about 25% give up in year one 50% in today soon after. Different if you had some inheritance and bought a house a few years back.
Junior Doctors starting pay is about ÂŁ29K less tax, NI, interest on your student debt (150K of so) of about ÂŁ10K, commuting costs, ULEX, congestion charges, lunches leaves them with about ÂŁ1,000 PCM for rent heat/light, insurance, repairs…so you might just about afford a room in a shared flat in London so long as you do not choose to eat, heat it or ever go on holiday.
True it might slowly rise to perhaps ÂŁ80K or so by 45 but you will never be able to buy a flat without family help let alone support children and a family.
Also bear in mind that they have already given up five or six year income just to qualify. And are bright enough to do load of other jobs. One medical consultant I know did a one year law conversion and now spends his time on medical negligence claims. Twice the pay half the work he says.
December 27, 2022
50% in total do not continue with the NHS
December 28, 2022
They could move, theyâd be very wealthy in Stoke even on the starting rate, or the North East, Wales, Liverpool.
December 27, 2022
Spot on LL, you have just described the dire economic plight of a Junior Doctor perfectly, which this out of touch Government care nought. My son is a classic example, six years studying medicine at Cambridge, now working 70 hour weeks as a Junior Doctor in a busy central London hospital. Weekends, nights, Christmas, all dumped on Junior Doctors. By the time he has paid tax, NI, student debt at 9% and his astronomical monthly rent, there is very little left at the end of the month to show for all that hard work. Sadly morale is very low amongst his peers and not surprisingly, he and so many fellow Junior Doctors he works with or went to university with have now decided they donât want to stay in medicine. What a waste. Retainment is as much a problem as recruitment if not more and Barclay and this Government are clueless about how to resolve that.
December 27, 2022
Indeed many I know are giving up medicine completely, others go to Australia or New Zealand for circa double the salary. What a waste of all those training costs.
December 27, 2022
+1
December 28, 2022
How much is he earning gross with all the overtime, the 30% and 60% uplifts for nights and weekends, the London weighting? I heard the central London weighting was only ÂŁ4000 (insufficient). His basic contract is for 37.5 hours isnât it? Wouldnât he be better off doing his early doctoring in another region?
December 27, 2022
Very good questions Sir John. Unfortunately they are far too complex for most of our ministers and current crop of politicians to understand. Their main ability seems to be to open their mouths and words fall out. Management consultants are little better. What have most of them ever managed?
December 27, 2022
I see that the govt. has a 3 year GP training scheme.
On the face of it a good idea.
BUT they just canât help themselves.
The further you look into the details the more mired in wokery the scheme becomes.
It is no way to rediscover those dedicated, clever, hardworking family doctors!
They loathed both govt. and NHSâŠand rightly so!
December 27, 2022
Having had to have to confront the Nurses over pay and suffer the political consequences , is it time for the Government to shut down the NHS’s demand for temporary staff? This seems to have become a racket that is costing the tax payer dear , poor management along with the agencies ability to pretty much black mail the hospitals into paying their fat fees in order to fill their staffing requirements is bleeding the NHS of a fortune. As the management are unwilling or unable to play hard ball, is it time for the Government to step in? Put in place a freeze of hiring temporary staff and starve the temporary nurses and doctors into taking up the permanent positions sitting vacant.
December 28, 2022
I know a female nurse who works two days per week bank/agency who earns over ÂŁ30k. But she is giving up her great pension doing that so sheâll have to switch back.
December 27, 2022
You have frequently called for a plan, I have often made suggestions. However tbe NHS trundles on like a wounded mamoth. How about retaining the phrase, “Available to all at the time of need”, free being misleading because for sure it never can be. Then start with an absolutely clean sheet of paper and design a health service fit for our time. We do not hanker after cars from 1947 why are we trying to perpetuate a health service from the same era. While the NHS has advanced medically, as an organisation for providing that medication it is still in the late 40s.
December 27, 2022
There was a recent TV interview, where a Surgeon was asked why the NHS could not set up “emergency” operations to tackle the backlog? He explained that he had recently organised a ‘push’ and arranged eight theatres (staffed with surgeons, anesthetists & nurses) with a long list of prepped patients – scheduled to start at 8am prompt. On the morning, there were only three hospital porters available, so five of the theatres had to be stood down. Backing up this statement, another Consultant described how having waited some time for his patient to be delivered, he finally took a trolley down to the ward and collected him himself. The hospital suspended this Surgeon for two months. You can throw all the money in the world at the NHS but it won’t solve useless managment.
December 27, 2022
Ian T.
I remember that interview and was equally appalled . I found it gob smacking that any bean counter should have the power to suspend a surgeon for making a medical decision. No doubt in the upside down world we are forced to live in that same bean counter got promoted when in reality he should have been made to walk the plank. I wonder how many race juggling managers that hospital employs.
December 27, 2022
I saw this too and thought about many places I had worked where similar things happened to the detriment of the customer.
December 27, 2022
Ian T. How crazy to suspend a consultant. The only people who suffer as a result are patients.
December 27, 2022
the patients might have gone private and found themselves being looked after by the same NHS suspended chap.
December 27, 2022
Good for them taking the pressure off the dire NHS and freeing it up for others.
December 27, 2022
+1 all too typical
December 27, 2022
Sir John,
We have trapped ourselves in a corner. The NHS is, despite its faults, a remarkable construction which adequately treats most people who need its services. Of course it is bureaucratic, of course it is not ideal, but its faults are the result of how it grew to meet the insatiable demand for healthcare. There are disagreements about whether the demand is manageable, but so far we can see no end to it. The question then becomes whether we can find an affordable response. Persuading people that change is needed before things break is going to be difficult.
There are some obvious partial solutions that can be tried. For example, the GP system seems to be under a degree of strain which is unacceptable. Hard-working and dedicated medical professionals can only be expected to do so much before burn-out and overwork means that early retirement loses them to the profession. The fault here seems to be the way GP care is structured.
Nursing staff are being trained to degree standard, something that is surely unnecessary in many cases. This should change. Overseas staff are stolen from countries which need their services, a morally unacceptable situation. We cannot abandon the current system because the political fall-out would be immediate and lethal â Mr Barclay is being courageous in Sir Humphrey terms to even hint that some parts of the NHS are over-manned and indulged – but we can apply the VW solution.
When the Beetle was the only model VW produced it sold and sold and sold, but eventually the world moved on. The end was coming, a total collapse in sales, but it was obvious that any attempt to switch to newer models en masse would bankrupt the company, so a gradual changeover was needed, not totally efficient but sufficient. New models were tried in small numbers with resources then concentrated on the successful ones. Within a few years the Beetle was a footnote, but its reputation transferred to the newer models which is why so many Golfs etc adorn our roads.
A newer model of GP care is obvious, walk-in health centres with access to centralised data-bases which cover the entire UK population. If this works then the GP system will wither, if not, not. Apply this philosophy to the rest of the system, trying anything that works in other countries but not abandoning the current systems before something better is available, working and proving better for patients. Commercially supplied nurse training could be tried.
The Usian phrase âif it ainât broke donât fix itâ would be a good place to start. There must be a huge amount of suppressed expertise among those who can see the faults in the current systems, expertise which would point to ways ahead. And by applying the VW solution to those suggestions we can save what is good.
December 27, 2022
So if you’re unwell and need to see a doctor, Julian, you want to be able to go to a walk-in health centre and consult a database? Or some other medical person consults a database about you? Not a doctor? Sorry, but I don’t follow how this new model operates. The bottom line is, do you get to see a doctor or not? If not, because the GP system has ‘withered’, I wonder how confident you would be of being correctly diagnosed and treated.
That’s not to say the NHS doesn’t need improving, and I agree with your general point about introducing change gradually and retaining as much expertise as possible. I’m just concerned that changes could take the form of replacing with IT the pre-lockdown face-to-face contact with a doctor we expected. The Covid crisis was used as an excuse to keep us out of GP surgeries, and I fear that some health technocrats would like to make that permanent.
December 27, 2022
Do you recall that some years ago, the NHS attempted to develop a new IT system, and after spending more than ÂŁ10 billion (not million), it had to be abandoned?
December 27, 2022
I was on the fringe of that NP(for)IT bid and can remember some of the various industry ‘players’ who were involved. The media later made quite a fuss about the ÂŁ10B lost by the NHS but I don’t remember them saying too much about all the time & money the bidders wasted on that project. A huge IT project needs a small army of expensive sales, marketing and system support specialists to put together a realistic bid – and I don’t know how many millions were spent by them doing so.
What I do know is that they were dealing with a customer who knew very little about project management, who constantly moved the goalposts and who never even got it’s own team on side, let alone all of the contractors. With hindsight it was doomed right from the start.
December 28, 2022
A while ago, in those halcyon days when you could see a doctor, I saw my doctor and reported my symptoms. She consulted her computer. I managed to sneak a look. She was looking at a NICE Clinical Guideline. She was reading questions from a screen. As I answered them she ticked a box and the next question appeared depending on my answer. This took 6 years of training?
December 27, 2022
“The NHS is, despite its faults, a remarkable construction which adequately treats most people who need its services.”
Alas not at all. Fortunately I have never had any many serious medical issues but when I did they misdiagnosed my appendix three times before finally operating and I also had an infected & Necrotizing Cholecystitis *(Gall Bladder also misdiagnosed twice). Either could have burst and could very have easily killed me off at 30 and 52. Based on outcomes the NHS is a truly appalling system. Maternity care for my first born child was appalling too, very nearly leading to his death.
Burst appendix was the second commonest cause of premature deaths in young males until they regularly operated for the condition.
December 27, 2022
As mentioned earlier any NHS re-organisation cannot be undertaken by Trust managers who have put their own priorities ahead of patient care. It will need to be someone from outside government, local government or NHS administration. In the meantime quotas for medical/admin staff could surely be instigated – no managers such as the laughable “Lived Experience” position to be advertised until that Trust has enough medical staff, enough beds and enough convalescent facilities to solve the bed blocking problem. The Government can easily, if it so wished, solve the problem of older doctors retiring early because of the adverse tax problem and the Treasury should not be the department which decides how many doctors need to be trained – whoever gave them that responsibility anyway? Charging foreign tourists for their treatment should be mandatory not up to the feelings of the Trust managers. We should learn from our past as to what worked and also at foreign systems which all seem more efficient than ours.
December 27, 2022
You missed out the onerous hand of “diversity” on both costs and operations Sir John.
December 27, 2022
I do not understand why there isnât one. Top managements role is to maximise outputs from the resources available and to do that there has to be a working document (s) updated etc with Smart objectives.
The fact that you are asking the questions infers there isnât one with the Secretary of State and the Permanent Secretary complicit. My Member of Parliament, a Minister, proudly stated in his newsletter how much more money was being poured in.
When I responded that he was, de facto, supporting inefficiency if you looked at dropping outputs, he did not answer. I guess there is no leverage so the public will continue to suffer.
Your election slogan. âPay more taxes get poorer servicesâ
December 27, 2022
The phrase ‘Grandma’ and ‘sucking eggs’ comes to mind — Why on Earth do NHS Trusts and cabinet ministers need to be reminded of basic strategy?
Is it because of gross incompetence, ignorance, or have those that should be pro-active in these areas just given up trying?
December 27, 2022
You are absolutely right Crystalclear and here is an example. My wife was diagnosed with cancer after an ultra scan and referred to a Specialist at the RUH Bath. He said the next step was a CT scan and before arranging it we were introduced to a nurse who was to look after my wife through the procedure and who took us to another room to explain what would happen.
During this meeting it became evident that each stage would be about 3 weeks apart, ie scan in 3 week’s time, result discussed with the specialist 3 weeks after that, first consultation with an oncologist 3 weeks after that, then treatment would start again in about 2 to 3 weeks time. I questioned the time lag between each stage and was told this is how the system worked.
The next day after this initial meeting we decided to explore other avenues and we were recommended to contact a specialist at a Nuffield hospital near Winchester. On phoning his secretary we were offered an appointment 5 days away on a Monday at 11am which allowed enough time to get my wife’s records from Bath.
He confirmed the findings and asked if we had the time to wait for a CT scan, which of course we had. This was carried out at 1 30pm before the radiologist took a lunchbreak and an appointment was booked to discuss the result on the following Monday. TWO days later we met the oncologist at the Spire hospital in Southampton and the treatment was booked to commence the following week.
What was to take the NHS nearly 12 weeks, Private practice had taken 15 days. This is medical people working together and not having to abide by administrators rules and timescales at a huge wasted on-cost to the taxpayer.
BTW if you miss an appointment you can’t fill a vacant slot, it has to be a new appointment in 3 weeks time!!!!
December 27, 2022
â12 How can quality and productivity overall be improved?â
Sack all the highly paid âDiversity Managersâ and associated staff.
Diversity is a communist device designed to destroy meritocracy one of the Westâs most powerful tools, together with freedom of speech, for bringing equality and prosperity.
Diversity is like a cancer or myiasis of the institution devouring the institution from within by deliberately filling posts with incompetent staff and at the same time causing resentment and loss of camaraderie.
To quote Robert Conquestâs second and third laws of politics :
– âAny organization not explicitly right-wing sooner or later becomes left-wing.â
– âThe simplest way to explain the behaviour of any bureaucratic organization is to assume that it is controlled by a cabal of its enemies.â
December 27, 2022
No, Diversity Is Our Strength!
Every PM and senior politician says so and every officer in HM Forces.
Surely they can’t all be wrong?
December 27, 2022
“The principal aim of bureaucracies is to protect their own backs” = Professor Michael Burleigh
December 27, 2022
“NHS manpower plans”
Sir
“Manpower” does not sound gender inclusive.
Has someone from the NHS bureaucracy contacted you to make a complaint ?
December 27, 2022
It is a scandal that even a penny of the huge sums of extra money granted to the NHS in recent years have been paid, apparently, without any attempt to answer any of the basic questions you list. The present Government has shown no sign that it is any different from its predecessors in its craven inability to face up to the NHS cult and suggest that there might be other and better ways of doing things.
We should not forget too, that the extortionate marginal rate of tax for those losing their personal allowance, as their income rises above ÂŁ100k., applies to everyone, not just Doctors, and the Conservatives have never done anything to oppose it. The idea that they are a Low Tax party has now been confirmed as nonsense.
December 27, 2022
It is almost a waste of time questioning the efficiency of the NHS . I have over the many years of its existence done this – at the highest level . It is the largest organisation in Europe and is in a shameful state . Health Minister after Health Minister and Government after Government have all failed over this . The NHS should never have been extended into a National body ; it was not conceived this way . I sympathise with Sir John’s efforts today .
December 27, 2022
Just slipped up on a elastic band on the pavement.
Can the pay dispute be paid for by our postmen reusing elastic bands?
December 27, 2022
+1
Ah!
Not just here then?
A particular bĂȘte noir of mine!
December 27, 2022
Doctors get paid more than their counterparts across the EU, often much more. They earn so much they are able to work part-time and avoid tax issues because their pension pots are so large. In 2008 BMA members voted to cap the number of places at UK medical schools to “avoid overproduction of doctors”. In August 2022 it was reported “the number of places at UK medical schools are capped – in England this year there are 7,500 places. In 2020 and 2021 the government lifted the cap on numbers, which last year led to more than 10,000 places being accepted. But this year the cap in England is being reintroduced.. “.
These facts are all linked.
December 27, 2022
1. How many medical and support staff will it take to get waiting lists down?
Again, a focus on the wrong thing. Waiting times are what matters to patients, not the length of the list ahead of them.
If 10 people can be removed off List A in a day, but only 1 person from List B, a system targetted on reducing the length of the list will focus on List A even if the right thing to do is focus on List B. If you target and measure the wrong thing, you get the wrong outcomes.
2. What will it take to fill existing vacancies?
And what will the government do if the answer is “fund the nurses’ pay increase”?
3. Given the urgent need to put in more beds to hospitals, what extra staffing is needed for extra beds?
With the number of current vacancies and limited training places (which also have a long lead time), where will extra staff come from?
5. Doctors retire early with some saying it is pension tax rules. Can these be eased?
6. The tax system hits people when they go over ÂŁ100,000 a year where many doctors are. Can the anomalous 60% rate be reduced/ tapered better?
Both of these are a matter of government policy and are nothing to do with employment Ts and Cs in the health service. These are questions that need to be asked of the PM, Chancellor and the Cabinet.
9. Is enough being done to train more future nurses and doctors?
Unlikely when government policy seems to be one of outsourcing this training to other countries and then recruiting from overseas.
December 28, 2022
2. Free up lots more training places, flood the market. Start training from the age of 16 in our hospitals on the wards with day release. Paid whilst learning, earning qualifications at 18, 21 and 25.
3. Point 2 will help with that. We are told lots of patients donât actually need ânursingâ care just care until they are completely ready to go home.
5. Do you believe only Doctors should get pension tax exemptions? LTA introduced in 2006 by Labour. Originally set at ÂŁ1.5m reduced in 2012 and 2014 by Conservatives John, the Conservative government!
6. The only people with over ÂŁ1m pension pots not affected by the LTA are defined benefit public sector workers and ex-public sector workers! What happens tax wise when a psw retires age just 55 or 60 with over ÂŁ1m pension pot?
9. No! We should flood our market with nurses and have two levels of doctor training.
December 27, 2022
1. The plethora of targets that are being missed represent a complete failure of micro management by ministers. Do away with all of the targets and the futile management effort that administers them. And learn that declaring something in the House of Commons and making it happen in the real world are very different things.
2. For your local area, reinstate the outer London weighting payments that used to be in place. Far more is being wasted in agency costs than was saved by removing the weighting allowances.
December 27, 2022
I canât understand why we import Drs and Nurses when there are British kids who would like to train as medics but cannot secure a university place. 28k British kids applied for just 8k places on medicine courses. Yet we know the demand for Drs is insatiable. Why are we denying our own kids the chance of a medical career.
December 27, 2022
Medical courses in the UK prioritise foreign students because their tuition fees are not capped like the British fees, so universities make more money by filling their courses with foreigners. There should be a rule change that gives British students first chance at places but we all know this Government wants to increase immigration at the detriment of the indigenous population.
December 27, 2022
+1
Iâve always reckoned that the NHS was used ( maybe even created) as a vehicle for immigration/diversity etc just like sport has been.
Only problemâŠhow very cruel and racist to take potential health workers away from other countries that need them.
December 27, 2022
Strikes me that the answers given to questions 1-10 will be ‘we must have more money’. Claims that savings should be tried for elsewhere will be resisted until 1-10 are generously funded.
And of course major reforms cannot be made while costly committees are working on minor details.
December 27, 2022
I have tragically experienced the good and bad from the NHS in recent months. From a committee deciding that a cheap 59p test, routinely performed in most western countries, should be delayed approval because they wanted to do their own research, which never happened. A common, cheap rehydration powder no longer available in pharmacies. Test results that should have been a red flag. Unable to get an urgent GPs appointment. I and my family feel let down by the NHS and the only time all stops were pulled out it was too late. Lessons will be learned but quickly forgotten until the next time.
December 27, 2022
All sound, proper questions and I am stunned that they have to be asked now and that it is you who is doing the asking. Have we not had any health ministers for the last decade or so? Do we not have any NHS managers now?
December 27, 2022
The government won’t do anything to the NHS if it thinks it will lose votes and Labour will gain (“Hands off our NHS”).
People who use the service are not idiots and we know it is poor, but are frightened that any alternative will be worse. The government needs to demonstrate that that is not necessarily the case.
Commission some documentaries on user experience of the French, German Spanish etc health systems and put them in the public domain (cleary the MSM won’t do any such thing, but circumvent them by using YouTube etc).
Once people realise that alternatives are feasible, and they can be much better than what we’ve got NHS reform could be a vote winner.
That’s a big “could” but what’s the alternative?
December 30, 2022
Wanderer: “the government wonât do anything to the NHS if it thinks it will lose votes and Labour will gain (âHands off our NHSâ).”
There is a sort of perverse symmetry about this parliament. Boris Johnson was given the largest majority in living memory, he could have implemented loads of Tory policies, but instead he chose to implement WEF totalitarianism*. Policies never before implemented, even in wartime, resulting in the destruction of the British economy. In any case, at the end of this parliament, there is nothing the Tory party could do, that will get it re-elected. So it has as much freedom of movement as it had at the beginning.
NB. Klaus Schwab published a book about the pandemic before we knew about the pandemic.
December 27, 2022
I despair.
Practically all employees everywhere, however little they accomplish and however many staff there are, claim to be overworked.
It is not more staff that are needed but pay reductions for existing staff to match waiting lists and a little bonus for clearing the waiting lists – pay by results!
Pay by results much like what happens naturally to businesses and business owners in the private sector which is where hospitals (even if publicly funded) ought to go to improve efficiency.
If Sir John Redwood was speaking about the Ministry Of Defence where privatisation is not a sensible option, I could see the use of such questions but not so with a privatisable service (with many of these questions).
At the very, very least some hospitals should be privatised just as some prisons were privatised (with big running costs savings) so as to provide some yardstick of what running costs can be kept down to.
December 27, 2022
Yes indeed, I also despair at many many things in this country, and think the NHS should be dismantled and rebuilt on the lines of one of the better European health sevices. Access to such a service could be with the users NI number or an identity card.
December 27, 2022
Yes. I thought an NHS manpower plan had been promised but had not materialised.
Personally I suspect a lot of the rot set in when nursing became a Degree Subject. It was better when people became nurses because they wished to CARE for people.
You have frequently pointed out that there are means within the present system to pay nurses more. I don’t remember the details.
Let’s face it. One huge problem is that of all nationalised ‘industries’ – too many Chiefs and not enough Indians. Bureaucracy.
Also, nowadays, everything has gone ‘Woke’ – Diversity Rules!
I really could not care less what colour a doctor or nurse is, or even what religion, so long as I can understand what they are saying.
December 27, 2022
The IFS is reporting that the NHS has more money and more staff than before the pandemic, yet is treating fewer patients.
https://ifs.org.uk/news/nhs-2022-more-funding-more-staff-treating-fewer-patients-covid-impacts-linger
Many of us will have personal knowledge of friends and family caught up in the shameful state of A& E and ambulance services, in my case, I believe delays contributed to a death. It seems to me that there is no excuse for this situation to have been allowed to develop and the blame has to rest with NHS management, not politicians. Enough is enough :
The Health secretary should call in the top tier of NHS managers and fire those directly responsible for resource allocation for gross misconduct and definitely without compensation. He should not recruit their replacements from within, but go to the military and private sector for managers not tainted by recent failure, of which there have been many.
He could make a good start by appointing the Army’s head of resource management to take overall charge of that area of the NHS with a free hand to sort it out within the existing bloated budget. I have no doubt it can be done, but not by the current management, whose only answer seems to be to demand more money.
December 27, 2022
Regarding point (11), I would like to see some figures demonstrarting that agency staff are more expensive than permanent employees. In fact, the absence of any figures throughout the weeks (months/years?) that this issue has been debated, makes me suspect that in fact agency staff are lower cost.
If not, let’s have some figures to prove it.
December 28, 2022
https://www.nursing-personnel.com/?gclid=EAIaIQobChMIm5eNpoKc_AIV0NvtCh0fmgC0EAAYBCAAEgLI4_D_BwE
Earn ÂŁ50 to ÂŁ60 per hour.
This is an interesting one, do they have to pay Employeeâs NI on this or is it NI free? Do they have Nest workplace pension taken out of it at 5% or do they earn below ÂŁ6500 in part-time additional shifts? Do they get holiday pay for every 9 shifts they work?
December 27, 2022
Firstly the government needs to sack all the Arts graduates in the NHS from top to bottom who have created the situation that we now face. Arts graduates should have no involvement in healthcare. The government then needs to get advice from Germany/France on how to set up a functioning health system which is self-sustaining. The problems are manifold – too many part-time women, too few doctors, too many poorly trained third world doctors, too few doctors particularly men being trained here, patients having to wait too long for essential treatments, doctors having negotiated terms of service which are incapable of delivering functioning healthcare, the government wasting resources on collecting data which are irrelevant to health to facilitate cretinous MPs asking cretinous questions etc.
December 27, 2022
And how many unnecessary strategic managers and woke non-jobs could the NHS get rid of?
December 28, 2022
Sir John,
Your questions are extremely pertinent. However, the overwhelming problem with the Hospital Trust system is that it is being crushed by a huge, overpaid bureaucracy taking about half the total salary bill!
My wife and I have many medical Consultant friends locally and they all agree. The decision as to when a patient can have a procedure is not taken by them but by some barely educated administrative assistant.
There are two options for a radical change in the NHS and the first is to do away with Trusts and massively reduce the huge administrative burden, making it truly “National” with central buying with huge “buying power” reducing waste.
Put clinicians in charge as they do in almost every other country in the world.
The second is to have central purchasing but let the private sector take over all the Hospitals in the country. Private Hospitals are run with a very light bureaucracy. The Government would determine the profit level allowable to keep costs down to them.
The Government should abandon Univerity training for nurses and return to practical training and the State Registered status. This will immediately bring in more nurses.
The University quota for Doctors must be removed. This will bring in more Doctors.
Regrettably, I do not believe that this neo-socialist Government will do anything radical to ensure that we have an efficient, value-for-money, NATIONAL health service that properly serves our people.
December 28, 2022
Extra question:
Does nursing really need a degree?
Do foreign nurses need degrees? Since other countries don’t do this, does that mnean we are employing “under qualified” people from abroad? And if it’s ok for them then why not for our people?
If there’s a shortage of nurses, could it be related to the artificially tortuous route to working in the profession that the need for a degree entails?
December 28, 2022
This may come as a shock, but I agree with everything John has written.
December 29, 2022
JR: “How many medical and support staff will it take to get waiting lists down?”
Well, you probably wouldn’t demand the firing of staff who chose to make decisions about their own medical health, viz declining to get a vaccine that turns out, not to protect from infection, not to protect from spreading the condition, and not to stop you dying from serious complications of the treatment itself.
https://www.channel4.com/news/factcheck/factcheck-tens-of-thousands-of-nhs-england-staff-face-dismissal-over-compulsory-vaccines
Threatening an employee with the loss of his or her job, is hardly a way to motivate employees, but in my opinion also contravenes the Nuremberg convention against compelled medical treatments, especially experimental medical treatments.