The productivity and output problems in the public sector

I have pointed out before that the UK uses a different statistical presentation of public sector health and education to comparable countries. The UK attempts to proxy output of these services, rather than just including their costs. This led to a faster decline in UK GDP when the lockdowns occurred, as both services cut back on the measured outputs which included numbers of pupils attending schools and numbers of doctors consultations. This same scoring system is now losing us GDP because these core services have not got back up to pre covid levels of output despite big increases in spending. Indeed, the latest poor figure for GDP with a 0.5% fall in the last month had as it largest negative a further decline in health output thanks to strikes in the NHS.

The quirky presentation is telling us something real and of importance. It would not be right to bump up our output  figures for all that extra public spending when it is not delivering gains in output. There has been a large decline in public sector productivity in the last three years which has coincided and maybe resulted from the excessive increases in spending committed to the services. This productivity problem  now lies behind some of the big political rows going on, though there is still a reluctance by the opposition parties to discuss what you should do about the way putting more money in does not necessarily result in more service coming out.

The one row where productivity has been openly discussed is over the backlog of illegal migration cases. The Opposition accepts there was a bad decline in the number of cases dealt with by each employee in the service. Their answer to the problem is to recommend more staff , and to propose better paid and more senior staff. Ministers  have committed more money to the budget and have recruited more people to try to shift the backlogs and report that more cases are  now being decided per employee  after a period of very low output.

We live in a world where Ministers are responsible for the productivity but rarely have the powers to directly hire, fire, and manage the staff. The case seems to raise the issue should Ministers  have removed senior managers when output fell off? Should they  take more powers to reward, offer incentives and become more involved in recruitment? Why did productivity fall off so far? Why didn’t senior managers in the department take action to tackle it, or alert Ministers and ask for assistance and resource to do so? I cannot believe any recent Minister wanted there to be a collapse in productivity or who would have blocked moves to tackle it if it had been accurately reported early enough. Ministers were setting targets to get more done and had as a policy reducing the backlog.

The bigger one that is similar is the target to get NHS waiting lists down. The Ministerial wish to cut these has been clear throughout. Ministers  have provided large general increases in money to the NHS, and have offered additional specific sums to get waiting lists down. Why hasn’t that worked? I will develop these issues in future blogs.

83 Comments

  1. Lifelogic
    September 16, 2023

    Perhaps even more to the point is:- Will this state sector output be of negative value, positive value or zero value of or any benefit for the tax payers who are forced to fund it? Is it providing anything that is remotely wanted by or of benefit to the people?

    The government have spent many hundreds of £ billions on HS2, test and trace, net zero, road blocking, the net harm vaccines, the pointless lockdowns, Blair’s and others counterproductive & idiotic wars, organising QE & Sunak’s damaging inflation
 clearly all spent to produce vast net harm or at best nothing of value for tax payers. The horrendous vaccine statistics show huge net damage caused by the dangerous Covid vaccines. This in many thousands of excess deaths and injuries. Many coerced even into young people who had zero need of any protection from Covid even had the vaccines had been remotely “safe and effective”.

    The vaccine damage has prob. even outweighed all the positives done by the whole of the rest of the NHS. If so the whole of the NHS budget may have produce zero of net value in health terms. The net zero agenda will cost ÂŁ trillions, but just gives us expensive and intermittent energy, frozen to death pensioners, huge economic damage, exported jobs and whole industries and less plant, tree and crop growth.

    Well done our wonderful state sector and their “experts”.

    1. Lifelogic
      September 16, 2023

      The taxation to fund the hugely bloated and generally inept and misdirected state sector also does huge net harm even before the government spend the funds extracted in often
      doing further net harm. This by depriving people of the money they need and that they would have spent or invested it, almost certainly, far more wisely. This by altering the ways they organise their affairs or investments to mitigate their taxes and by time wased doing this and by other compliance costs accounting, tax advice, restructuring costs…buying an EV car because the tax system encourages it despite it being far less sensible or efficient other than for these artificial and misguided tax incentives and market rigging.

      1. Jim+Whitehead
        September 16, 2023

        LL, ++++. Two excellent postings, but all too sensible for our wretched representatives to take any note of.
        How has it come to pass that I find myself siding so passionately with Russell Brand !!??
        Why are so many eschewing the propaganda tsunami of the BBC in favour of the articulate questing and forensic analyses of Neil Oliver, Laurence Fox, Dan Wootton, Nana Akua, etc. on GB News, and the courageous Mark Steyn?
        The answers are obvious. They centre around Truth and Deception . . . .

        1. Lifelogic
          September 16, 2023

          Exactly.

      2. Lifelogic
        September 16, 2023

        So the US “experts” still want to give Covid vaccines to people over just six months old and the UK’s “experts” have finally accepted that it should be over 65. A tragedy (criminal perhaps) that they did not do this when the new tech. “vaccines” were first rolled out. Personally I cannot see that the statistics show any net benefit, even in old age and will not be taking them. So much for experts and “following the science”. They do not seem very statistically numerate or logical to me.

        Giving them to young people over six months (even now we know of the huge damage they have done) seems criminal to me, given the risk benefit figures that we have.

        Dr John Campbell’s new video on this is well worth watching.

        1. beresford
          September 16, 2023

          The Government have bought a large batch of ‘vaccines’ from Pfizer. Why not kill two birds with one stone and legislate that every boat migrant must be ‘vaccinated’, forcibly if necessary, before leaving Dover docks? The Prime Minister insists they are safe and protect others, so who could object to protecting ourselves against unidentified individuals from parts unknown. I suspect the numbers of Channel crossers would drop dramatically.

        2. Jim+Whitehead
          September 16, 2023

          LL, ++++ Dr. John Campbell saw the light, belatedly but, my word, how his revelations and his integrity shine forth, and such a contrast with the ineffectual journalism of most of the MSM.
          There are many heroes to salute in these times of Vichy collaborationists.

          1. Lifelogic
            September 16, 2023

            Indeed.

    2. Everhopeful
      September 16, 2023

      “enormous amounts of investment only produced modest increases in production or none at all. … In short, the Great Leap was a very expensive disaster”. Economist Dwight Perkins.
      Apparently these failures of were blamed on the more pragmatic “rightists” who no doubt held as little power in China during those political upheavals as they do here and now.

      1. Everhopeful
        September 16, 2023

        ***Failures of “The Great Leap Forward”.

    3. Lifelogic
      September 16, 2023

      Sunak rejects reprieve for petrol cars to hit 2030 I see in the Times. So is the man bonkers, totally ignorant or just acting for vested interests? Does he not know that replacing your old petrol car with a new EV car almost always increases CO2 and wastes lots of money too. This even if it is charged entirely on low CO2 electricity (which it will not be as we have none spare).

      Still he sticks to his private jets, first class flights, and helicopters, building HS2 and burning wood at Drax so clearly he does not really give a damn about CO2. So what is his real agenda?

      1. Everhopeful
        September 16, 2023

        😂Oh come on

        Give the man a chance

        He’s banning dangerous dogs. (No doubt part of the no pet agenda).
        How much BETTER our lives will be for that!
        I mean I scarcely dare go out for the huge packs of rabid dogs roaming around the streets.
        What care I for full boats and fuel bills and poking the bear and all that old stuff.
        Sabre toothed dogs are what we want gone!

        1. Everhopeful
          September 16, 2023

          Another great success..making cat chipping a legal requirement.
          Making sure of course that an ill treated cat can not run away and be rescued.
          If there is a chip no vet will touch them without the owner’s permission.

      2. Bingle
        September 16, 2023

        The same story suggests that Ministers ‘promised’ BMW that there would be no reprieve of the 2030 ICE decisions if the Chinese MINI were to be assembled in England.

        Note that there is little to no manufacturing involved in assembly.
        Designed by China, built by (Chinese supplied) robots springs to mind.

        Rishi is acting like a marketing rep with the key to the cash box, rather than the CEO of UK PLC.

    4. Ian B
      September 16, 2023

      @Lifelogic +1 You are mainly forced to pay for the new up and coming discrimination departments. Discrimination is now more important than recruiting the ‘best of the best’

      1. Lifelogic
        September 16, 2023

        They call it “diversity”, but you are right it is indeed just reverse discrimination. Do we really want inferior RAF pilots, police, surgeons, air traffic control people
 due to them being selected for diversity rather than ability. Note that you cannot do both at the same time unless by some one chance in a few million it just happens to give you both.

    5. Donna
      September 16, 2023

      Thanks to the Net Zero lunacy, 3000 jobs will be lost in Port Talbot – and taxpayers are being forced to fund them.

      And there will be many more decent job losses caused by the Westminster Uni-Party’s obsession with eliminating our 1% of annual global CO2 emissions – with the knock-on effects to our economy – and the jobs exported to Asia.

      https://www.telegraph.co.uk/business/2023/09/15/steelworkers-facing-redundancy-tata-port-talbot-net-zero/

      1. Lifelogic
        September 16, 2023

        Yet more economic and environmental insanity due to May’s moronic net zero and Sunak the globalist shill!

    6. Enigma
      September 16, 2023

      Well said lifelogic 👍

    7. David Bunney
      September 19, 2023

      Lifelogic, I totally agree! Much of the civil service is setup to do exactly what the public don’t want, but rather what the elites want. If you fund climate researchers to only ‘find’ dangerous manmade climate change, if you only employ other government department staff and regulators to promote models that show economic and social damage from these invented threats and ‘solutions’ which are in no way affordable, feasible or practical then they are doing extreme harm to democracy, freedoms, the economy, wealth of the nation etc. By this measure much of government doing what people don’t want, which is not in their interests and is destroying the economy and fabric of society are producing negative value for investment at an exponentially growing rate, however inefficient and ineffective the department is in doing its work.

  2. Peter
    September 16, 2023

    Too many overpaid incompetents in senior positions in public services. There are no penalties for failure either. Screw up in one health authority and you take redundancy but then find employment in a different health authority. It’s exactly the same system as you find in local government.

    The trouble is these people are often recruited as a result of political patronage – by both parties.

    What needs to be done is to strip out all the wasteful and damaging layers. Cost is a perfectly valid reason to do this. Labour is unlikely to do so and the current Conservative government increasingly acts like a Labour one. In any case Conservatives will not be in power for much longer, so will not address the issue anyway.

    1. Lifelogic
      September 16, 2023

      Well in the private sector you have to sell you output to willing consumers. If you produce worthless dross you go out of business. In the state sector however you can produce worthless dross or even negative value dross for ever and still happily continue to collect wages, pensions and bonuses.

      In reality it is even worse than this as the government rig the markets in so many areas like education, healthcare, banking, energy, transport, cars
 so that even in the private sector people are then encourage or forced to produce the wrong things due to government rigged markets, red tape, restrictive planning, misguided health and safety, HR regulations, road blocking, the net zero religion and (none neutral) usually idiotic taxation systems.

      So even the private sector becomes far less efficient than it could be.

    2. Lifelogic
      September 16, 2023

      No so much “incompetence” as they simply do not have any real incentive to provided what their “customers” the public actually want. It is not their money nor they who benefit from the “services” they provide. The only incentives tend to be how can we make some more money by charing for a licence for this or that or by dining people for this or that. We have police whose approach is do nothing if at all possible (unless you can get a fine of someone), local authorities and endless arms of government (GDPR, planning, building control, road managment
 with a similar approaches.

      I see that Woking council have managed to go bust with debts of circa ÂŁ60k per household in their area. Surely deliberate negligence rather than incompetence? Doubtless the people who did this will never have to pay anything just tax payers and council tax payers and ever more mugged motorists mugged as they try to avoid all the (rarely repaired) pot holes.

    3. Ian B
      September 16, 2023

      @Peter – agreed
      As an illustration
      The UK navy has 34 Admirals. The position of Admiral is someone that commands and controls a fleet of Ships.

      UK Navy has 70 ships, which includes HMS Victory, but no real fleet. Roughly speaking 30 to many Admirals. As half of the ships are not for frontline defence. The 2 aircraft carriers can only support one style of aircraft rendering them useless as a type, and these aircraft in reality are the type the can defend themselves and the carrier, but have little or no other functionality. There is no capability for attack, or reconnaissance aircraft on these carriers, these have been deliberately excluded by the MOD.

      Extrapolate the above to every other entity this Conservative Government gives our taxpayer, every other are that this Conservative Government is paid and empowers to mange and you see the problem – it is them, them alone that are crippling the UK.

      1. Lifelogic
        September 16, 2023

        +1

    4. Jim+Whitehead
      September 16, 2023

      Peter, “wasteful and damaging layers” or lawyers, or both?

  3. Lifelogic
    September 16, 2023

    You say:- “The one row where productivity has been openly discussed is over the backlog of illegal migration cases. The Opposition accepts there was a bad decline.”

    But you very rarely deport anyway so is there any point in determining the merits of their cases unless you do deport promptly once determined?

    Surely just a waste of time and money without this.

    1. Everhopeful
      September 16, 2023

      +++
      Definitely.
      And it must be impacting the so-called “health service” surely?
      Ghastly outfit. Like a foreign commie state operating under its own berserk rules.

    2. Donna
      September 16, 2023

      Sunak and Braverman are “getting the backlog down” by effectively declaring an amnesty for most of those caught up in it.

      A few Albanians are being returned since their claims are obviously nonsense (and crowed about for PR purposes) but as far as the rest go, any rubbish/lies they spout to justify their application is being accepted …… and they will be a drain on this country for the rest of their (and in due course their extended families) lives.

    3. Bloke
      September 16, 2023

      During the past decade or longer, most UK state organisations and essential services have been failing. Incompetence is reported as prevailing through so many issues including: NHS, tax, care homes, housing, mortgages, crime, police, law, prisons, drugs, regulators, trains, cars, roads, air travel, water, energy, environment, employment, pensions, benefits, defence, BBC, immigration, fraud, knife crime, overpopulation, shortages, corruption, general carelessness and more.

      Is there one or more UK Govt departments that have performed efficiently without major error within the past five years?

    4. Peter D Gardner
      September 16, 2023

      Yes but deporting them would require real political will and effectiveness as distinct from productivity. So it won’t happen.

    5. Lifelogic
      September 16, 2023

      Only concentrate on determining the ones where deportation is likely to be possible. This is surely far more sensible.

  4. Ian+wragg
    September 16, 2023

    NHS waiting lists are the means of rationing health care. Anything that is perceived to be free will be overwhelmed.
    Unless you are a gimmigrant with gold plated human rights you cannot see a GP get a date for elective surgery or your child in your preferred school.
    The pu lic sector is in the main workshy and incompetent very much in keeping with our elected MPs.
    A massive clear out is required.

    1. Lifelogic
      September 16, 2023

      Indeed you either ration by price or by not supplying or by long waiting lists or GP have a “just piss of mate” phone queueing system
 the NHS have your money already so patients are just a cost nuisance to be deterred if at all possible. Pushed from GP to Casualty to Social Services and back yet again.

      In private healthcare they are customers to be found and encouraged to attend for treatments. Though there are often problems with over treatment or a preference for more profitable treatments in the private sector too. In the US for example cesarian births are surely far too high but in the UK far too low and with rather dire consequences as we see in the many appalling NHS maternity scandals. With vast compensations being paid out for endless negligence.

    2. Timaction
      September 16, 2023

      Serious reform of recruitment and selection processes from top to bottom are needed in all our health and public/emergency services. Blair, Campbell and Meddlesome created this as a self fulfilling lefty prophecy and the Tory’s have utterly failed to reform it after 14 years! Only then will the pc/woke culture that puts every minority party or interest as its priorities stop. Look after English people, their needs, values and culture first. Others should adapt to us, not visa versa. The left leaning nature of all those organisations needs to be broken. We need a return to meritocracy and active supervision and intervention management in the office, not from home. Then we need to repeal most of the inequality laws and all of the net zero/climate change legislation. Human Rights laws should also be repealed. We didn’t need them before Cherie encouraged their creation for her Chambers, we don’t need to fund them now. Quitting the ECHR would also help. The list goes on and is obvious to all conservatives, just not the Tory’s.

  5. BOF
    September 16, 2023

    I have no doubt that a Labour government will give blanket approval for asylum claimants/criminal migrants.

    They will then claim a massive improvement in productivity!

  6. Charles Breese
    September 16, 2023

    Two comments:
    a) About 10 months ago I started the process of trying to get a hearing aid via the NHS. I still don’t have one – this pace of progress is poor because deafness is widely regarded as a precursor to dementia, which is costly for society to handle. My experience (relating to a straightforward task) has illustrated that the process is dysfunctional with resource being wasted on activity which results in no progress. Before being handed any more money, the NHS should focus on how to ‘get things done’ cost and time efficiently – a surgeon recently wrote to the Telegraph saying that he now operates one day per fortnight vs. 4 days per week earlier in his career, with the causes being lack of availability of support staff and increased form filling.

    b) In business, there are people who are particularly capable at ‘getting things done’ cost and time efficiently. Experience suggests that this skillset is in very short supply across the entire public sector. It would be worth researching what characteristics give people this capability – I suspect that it is a combination of intellectual energy, commonsense/logic and a fairly high level of helicopter vision – Daniel Kahneman’s work would provide a good starting point for such research.

    1. Peter D Gardner
      September 16, 2023

      Far better to say that none of those involved in providing you with a hearing aid do not get paid until they have not only provided you with yourr hearing aid but provided you with the one best suited to your needs.

      1. Peter D Gardner
        September 16, 2023

        Oh what dreadful English. Sorry. try again. Far better to say that none of those involved in providing you with a hearing aid get paid until they have not only provided you with your hearing aid but provided you with the one best suited to your needs.

    2. graham1946
      September 16, 2023

      This I guess is due to the current government/organisation. I was in a needed an aid during the Blair years. I attended audiology, was given a hearing test and walked out with the correct aid all in the same appointment, dispensed by the audiologist. Why that cannot now happen, I just don’t know, but I do know that the health service is infinitely worse since 2010, and I am by no means Labour supporter. The Tories ruined the NHS in their 2012 Lansley re-organisation which resulted in duplication, more form filling wasted extra money and loss of staff. They never wanted the NHS in the first place. I suggest you make a nusiance of yourself and don’t just accept what has been dished out so far. Get on to PALS at your local hospital and make a complaint.

  7. Donna
    September 16, 2023

    Sir John, this reads like a “Not Me Guv” justification for the chaos this country is now engulfed in …. after 13 years of supposed Conservative Government, but which has been not even remotely Conservative throughout that period.

    The problem, as many below the line have been saying for a very long time, is that this country is now completely controlled by the WEF, left-wing Civil Servants and left-wing Quangos.

    Does anyone seriously think that WEF puppets Sunak/Hunt will do anything about that? And Starmer obviously won’t since he’s jumping to Blair’s tune, and it was Blair who largely created the Permanent Socialist State.

    It’s going to get a great deal worse, but then that’s what the WEF wants: so it can “build back better (for them).”

  8. Denis+Cooper
    September 16, 2023

    Off topic, today is the 31st anniversary of Black/White Wednesday:

    https://en.wikipedia.org/wiki/Black_Wednesday

    And here is an interesting article:

    https://eastangliabylines.co.uk/uk-path-to-membership-focus-on-how-we-can-add-to-europe/

    “UK path to membership: focus on how we can add to Europe”

    We now need to refer to Rejoiners, rather than Remainers or Remoaners.

    1. herebefore
      September 16, 2023

      Denis this is all pie in the sky stuff they’ll never have you back again not in a million years
      Maybe sometime with an outsiders deal and you know what that means – tradesman’s entrance

    2. Lifelogic
      September 16, 2023

      Then we had a Tory (John Major) pointlessly created economic disaster. But one that rectified itself quite quickly once we left the moronic ERM and interest rates then fell very rapidly. Major idiotically had claimed or lied(?) (before white Wednesday) interest rates would have to go up even further if we left!

      Today we have another economic mess created by the Tories Cameron, May, Boris, Sunak (as chancellor and PM) the solutions are very obvious far lower taxes, far less state sector, a bonfire of red tape, cut out the vast government waste, ditch net zero and go for cheap reliable on demand energy – alas our largely moronic MPs, ministers & the globalist shill in charge still have the complete reverse agenda!

  9. Bloke
    September 16, 2023

    Performance-related pay would remedy much of what is amiss. In the absence of productive output at least there is less money wasted, enabling taxpayers to buy better elsewhere if alternatives exist.

  10. DOM
    September 16, 2023

    John knows the real answer to this productivity issue but as ever with Tory MPs he like all the rest of his party avoids referencing it for obvious reasons.

    Declare war on the Left who are destroying this nation and our freedoms or maybe simply retire and pass on the baton to someone who will

    1. Hat man
      September 16, 2023

      Just making a declaration of war is only the start, Dom. You then get into a lot of questions. How do you prosecute the war, what allies do you have, what resources can you use, where exactly are your enemies, how do you defeat them, and what counts as victory? Sir Keith Joseph and Margaret Thatcher in the 70s, would have planned their war on the unions in that well-planned way, and it ultimately succeeded. Is there anyone doing that kind of planning now, do you think?

    2. Jim+Whitehead
      September 16, 2023

      DOM, ++++++.
      The target is massive, it is soft, and you keep hitting it hard, and the Pusillanimous Party is as befuddled and irrelevant to the times as was the utterly misguided Callaghan Healey administration.
      Fortunately there was the successful vision and indefatigable courage of Margaret Thatcher to come.
      I see no such qualities emerging from the ranks and rows of the H of C on either side

    3. Everhopeful
      September 16, 2023

      +++
      Trouble is though

      He is a conservative along with (8) ? others held hostage in a nest of commies.
      He can only do what he is doing. Which has to have some impact.
      And if that plumber was correct re heat pumps then I’d say that the tide may just be marginally turning?

  11. Bryan Harris
    September 16, 2023

    How many more times do the facts have to be shown, that throwing a load of money at a problem means nothing unless the target becomes more effective and better managed.

    How much of the ÂŁBillions gets siphoned off that should go to frontline NHS services, to woke hires and extra useless managers.

    NHS staff are still being actively recruited from abroad because NHS management fail to hang on to UK staff – They simply do not know how to motivate and look after their own people.

    1. Jim+Whitehead
      September 16, 2023

      B H, ++++ But the baleful presence of the CQC looms over every shoulder of every employee from top to bottom of the mouldering NHS and healthcare and welfare institutions of the country.
      Politicians hide and deflect with the CQC as the convenient cover for inaction.
      Like Ofcom, it deters criticism by its tacit threat to livelihood.
      Ask your GP, your nurse, Care Home staff, your Dentist, and await the ‘hair dryer’ reply.

      1. Bryan Harris
        September 17, 2023

        Very interesting – thanks Jim

  12. Peter D Gardner
    September 16, 2023

    I am sure Sir John has thought of the option of hiring chief executives from the private sector. It was done some years ago in defence with the appointment of Sir Peter Levene to head Defence Procurement. However that may not be appropriate because there is a big difference between a department that, in essence, only contracts the private sector to deliver equipment projects and to provide technical support and one that primarily delivers services through its own employees. Horses for courses.
    So it comes down to incentives for those already in position. I would go much further than Sir John’s proposals and restructure the NHS on the same principles that underpin the Australian health service. In essence patients decide who gets the available funding by choosing their GP, choosing their treatments, choosing who treats them and where. Providers get paid if and when patients decide they’ll be paid. These incentives are entirely absent from the NHS. It would not cost much more per head than the NHS and outcomes would be far superior.
    Good outcomes are not the same as productivity. A patient seen counts for productivity but not for positive health outcomes.

  13. William Long
    September 16, 2023

    What you are describing are the results of the reluctance of politicians of all parties, and for many years, to confront and deal with the structural problems in nationalised institutions, in particular, but not only, the NHS. It should be clear to any thinking person, but apparently this does not include Government Ministers, that these go far deeper than anything that can be solved by just more money; this after all has been the standard cure for many years, and it has not worked.
    But confronting problems, raising debate and making changes requires courage and communication skills, qualities that are almost totally lacking among modern leaders. It is so much easier to concentrate on things like Net Zero and HS2 of which the results are unmeasurable in the short term and provide great scope for posturing and the virtue scoring.

  14. agricola
    September 16, 2023

    When productivity falls below acceptable norms in private business they go bust.

    In the public sector they just ask for more money (Tax paid by all those in work and pensioners with private pensions paid for out of pre-taxed income.)

    I ask as one of those bracketed:-
    1. Who hires and fires in the public sector.
    2. If the answer to (1.) is senior managers, who audits their performance.
    3. How much political control exists via ministers to ensure a department works efficiently if profitability is difficult to quantify.

    In terms of (3.) For example , who controls the Home Office and is directly responsible for their abysmal vetting of immigrants, and the horrendous direction and control of our police forces. Someone within it must be responsible, they cannot continue using the minister as an Aunt Sally. If a minister carries the can, he/she must hire and fire.

    As to the NHS. I have always thought that we have an excess of none medical staff, 47% of those employed , and insufficient medics. Train medics for free against a contractual obligation to serve the NHS for 10 years after qualifying as nurses, radiographers, pharmasists, GP doctors, consultants and any medic I have omitted. Then look at reorganising it so that they can all be productive, measured against life expectancy and ailments cured or controlled. Lastly consider how best to pay for it taking in patient responsibility.

    1. agricola
      September 16, 2023

      Adendum.
      Having read Lord Vengeful in the DM today, any incoming government has a mojor challenge to reset the relationship between Government and Civil Service. It musf include hire and fire plus career path control at the senior level. We can no longer tolerate scribes who work against elected government and the peop le of the UK. Ministers need the support of a loyal reliable Cjvil Service not tbe current fifth column.

  15. Bloke
    September 16, 2023

    Productivity test for tax:

    How many different sources of tax are there?

    Taxpayers settle one sum for each tax year.

    Why does the English translation of the tax code involve 10 million words of rules and explanation over 21,000 pages?

  16. Mike Wilson
    September 16, 2023

    Relax – get yourself a job in the public sector. It’s always been inefficient. Why wouldn’t it be? The money just keeps rolling in. Now they’re ‘working from home’ it is the end game. It’s an endless decline – with more and more borrowing – until there is a debt crisis.

    The Tories are useless. Labour will be worse than useless. The Lib Dems and Greens are certifiable. Relax. No point fretting. Nothing can stop this juggernaut.

  17. Mike Wilson
    September 16, 2023

    The Met added it was collaborating with shops across London to improve reporting of shoplifting.

    That’s from the BBC news web site today. Well, as long as the REPORTING is improved.

  18. Clough
    September 16, 2023

    Dear Sir John, I’m no economist, just an ordinary punter trying to understand a complex subject.

    You seem to be implying that spending is a better way of measuring GDP. How can spending on a business or economic sector be a way of measuring its output? Surely the way you say the NHS measures productivity is the only way to do it?

    Reply Usually that is how GDP is calculated. Companies notify their turnover, not numbers of widgets. I said I saw the reason why the ONS goes for other measures for health and education

    1. Clough
      September 17, 2023

      So the more we spend on the NHS or the civil service, the more ‘productive’ they are? Or the more they ‘produce’?

      Why isn’t spending just a measure of spending? I hope you can understand my puzzlement about how this productivity idea is measured, Sir John.

  19. Ian B
    September 16, 2023

    To many people chasing vast amounts of taxpayer money, so inventing functions that have little to do with anything.

    One that has just been highlighted, the MOD staff stands at 59,900 and increase of 7% in the last year, the actual fully trained army target is set at 72,000. Moving to one administrator for each person doing a job. The argument goes the Army has to be reduced to match income to the Public Purse – strange logic if they then increase ‘administrators/the back office’ to support a reducing front end.

    This follows everywhere that this Conservative Government is paid and empowered to manage. They demand more tax to pay for frivolous Empire Building throughout the State Sector. What is never attached to the money ‘give away’ is a required result. This Conservative Government is incapable of ‘managing’, carry-out good house keeping in all the areas they throw our money at. They are prolific spenders, they put spending ahead of earning – ‘the economy stupid’

  20. Original Richard
    September 16, 2023

    At the bottom of all our state paid institutions – civil service, quangos, NHS, judiciary, police etc we are travelling towards the USSR position of “we pretend to work and they pretend to pay us”.

    At the top of our state paid institutions we have an elite who are determined to destroy the country’s wealth and democracy with Net Zero and deliberate social upheaval caused by the massive immigration of cultures quite different to those they are trying impose upon the native population.

  21. Christine
    September 16, 2023

    The behaviour of many people who work from home is appalling. They tell me how they do their housework, walk the dog and even get in a round of golf during working hours. This behaviour isn’t restricted to the public sector in fact all the cases above are large private companies. I worked in both the private and public sectors all my life and watched productivity fall over the years. So what were the main causes in my opinion?

    1) Too many emails that add no value. It’s far too easy to forward or send an email to hundreds of people with the click of a button. That one email may take a few minutes for the sender to read or write but multiply that up by the hours wasted by the people receiving it at the other end. We didn’t have this problem in pre-computer days.

    2) A lot more part-time workers. These workers still have to read and process the email dross that is the same size as a full-time worker but it takes up a larger percentage of their productive time.

    3) The biggest problem with the public sector is sick leave. As a manager, it’s nigh on impossible to sanction or dismiss staff who abuse sick leave. Just compare the amount of sick leave taken by the self-employed with employed workers. Not only that but the person taking the sick leave is actually rewarded because whilst they are off they accrue their annual leave to take when they return. More incentives and rewards should be implemented for those who work hard.

    4) There are too many managers, particularly in the public sector. I was an IT supplier for a large Government agency. For every project, I had to face a weekly meeting with up to 12 managers who added no value to the process. When the work was done in-house it was much more efficient. When adding staff add those who actually produce something.

    5) Too many non-jobs like diversity managers who add to the email burden, create stupid courses that waste people’s time, and take away funding from beneficial productive activities. Ask anyone if they would want an extra doctor or another manager and I guarantee they would vote for the doctor.

    We have become a lazy, get-something-for-nothing society. The Western world will be the cause of its own demise. Most of the problems stem from initiatives created by politicians, the UN, the WEF, the WHO, and the latest incarnation of the SDG the Council for Inclusive Capitalism. It is the SMEs that are the powerhouse of productivity but they are being crushed by bureaucracy. I expect this is the intention of large corporations that can carry these parasites more easily.

  22. RDM
    September 16, 2023

    “Public Sector Productivity”, this Government can’t even sort out Steel making Productivity, in the Private Sector!

    Now, we’ll be importing massive amounts of Scrap steel, the gap in raw Steel production, and the C02 associated with all it’s transport, etc,…

    The direct loss of, More than, 3000 high Value jobs, not including supply company’s!

    All for the sake of a Cheap Energy Strategy!

    And, the most resentful point about yesterday, was the Labour Liars were allowed to claim (S Kinnock) that Electric Arc, Hydrogen, and ÂŁ3bn was a solution!

    Currently, it is Not! And, there is no proof that it will ever be Economically Efficient, or even Environmental efficient!

    Hydrogen is NOT! Although theoretically, it needs massive amounts of energy! See below, the Swedish company’s trying, they are owned by the Swedish Government, and have large subsidies (State dependency, with Devolution and Labour control, which what they want)!

    Electric Arc is for Scrap, Steel Production, we will need to import new Raw Steel!
    And, ÂŁ3bn subsidy would only be the start of it!

    Swedish Green Steel making;

    Cheap Energy supply; Vattenfall (100% Swedish Government owned, Nuclear + Gas + Wind) https://group.vattenfall.com/

    Steel Making? SSAB (part own Swedish Government owned): https://www.ssab.com/en

    https://www.ssab.com/en/fossil-free-steel/faqs-the-big-questions-answered
    “SSAB produces steel based on both iron ore (blast furnace route) and recycled steel (electric arc furnace route).”

    Labour will Luv this idea because it will mean a Marxist State, with control of industry!

    But, for the Conservative Party to come up with this, will be Suicide Politically!

    And, you talk of Public Sector Productivity!

    Next you’ll be talking about cutting Benefits, or should I say, Wages Subsidies (UC) for big company’s?

    1. Donna
      September 16, 2023

      The steel industry should be protected as a matter of national defence/security.

      By forcing these job losses and end of new steel production, the Blue-Green Socialists are deliberately wrecking our defence and security capabilities.

      1. RDM
        September 17, 2023

        Well said!

        But, the truth is, there is a Marxist pulling their stings, which means, they wouldn’t know how to make a strategic decision, as obvious as the one you make!

        The sooner we scrap Net Zero, the better!

        A Marxist with an Ego, a narcissist, but think as shit!

  23. Christine
    September 16, 2023

    The EU has just passed a new rule coming into force next year whereby companies with more than 500 staff, reducing to 250 staff the following year, have to collect environmental, social, and governance data on every single company up and down their supply chain.

    This will impact all firms that supply parts to the EU. I expect our Government will be following suit. The aim seems to be to crush all SME businesses by making our companies less competitive. It also gives them an incentive not to employ more than 250 people.

    Who will police this new rule? Yet more bureaucrats? What happens to the data?

    Net Zero will be the death of the West.

    1. Timaction
      September 16, 2023

      It’s ok. The Tory’s climate change committee will come up with some money making solutions to prevent our manufacturing being exported to the East to import the same goods back made by coal powered power stations in dirty ships, half way around the planet. Um, how about carbon capture at many gazillions of ÂŁ for……. no purpose. FFS. You couldn’t make up how stupid our Westminster Village idiots are and their useless, gullible MSM. Net zero climate change targets for UK will save 0.000012% of the planets CO2. A plant food, without which we would all die. We should all insist that our MPs spend a day reading Tony Hellers website.

  24. Bert+Young
    September 16, 2023

    Ministers do have some control !. For one thing they could prevent outside bodies from deciding on the economy – for too long major misjudgements have been made by the BoE . The influence of 10 Downing Street flows directly to most areas of communication and hence to the day to day lives of the country . The planning decisions that industry and commerce make are mainly on a 5 year horizon and the political base that exists directs most – if not all , Board Rooms . Stimulation is badly needed from the core to the outside followed by Ministerial capability and determination .

  25. Wokinghamite
    September 16, 2023

    “Ministers have provided large general increases in money to the NHS, and have offered additional specific sums to get waiting lists down. Why hasn’t that worked?”

    I suspect it is because there is such a huge gap between what patients need and the facilities made available to them that any modest amounts of new or additional funding are quickly absorbed or are already spoken for. The increases may not be large in the context of what needs to be done.

  26. forthurst
    September 16, 2023

    The Civil Service is run by Arts graduates. These people have no useful skills so they naturally gravitate to activities for which no skills are demanded by skilless politicians ie managing people who actually have skills. Hence the NHS is mismanaged by people who are not clever enough to become doctors. In Germany, the doctors run the show so obviously they have much better health services. When people who are not clever are put in charge of people that are, they inevitably produce sub-optimal outcomes. Are the doctors being underpaid because civil servants resent paying people with higher intelligence and onerous training than theirs?

  27. XY
    September 16, 2023

    Socialists will always recommend more staff. They know that civil servants largely vote for socialist parties (in their view, to protect their jobs).

    It’s sad to see how many people are prepared to trash their country for personal gain.

  28. a-tracy
    September 16, 2023

    Open Democracy said In 2019, home secretary Priti Patel scrapped Home Office targets to process most asylum claims within six months, saying it would prioritise claims from children and the most vulnerable instead. However, the inspector found no evidence of any case being prioritised. Why are cases being lost? What analysis is done? Is it technicalities?

    The critique against her was often targets dehumanise people and 50% of those deemed removable, won their appeals. There seems to be a rather large business in legal fees to allow people to stay rather than ask people to go. Are these private lawyers on legal aid and charity aid on a lot more money than the legal people who make the decisions? Perhaps you are using too many low grade workers in this department and not enough legal people paid the same money as lawyers on the other side.

    How many people used to arrive each year in the back of lorries, we saw those tragedies of people dying in the back of those lorries a couple of years back. Is it harder now to come by lorry, ferries now go direct to Ireland, and perhaps that’s why they are in boats? How many more people per year are claiming asylum in the UK than in 2010? We read all the time of people still in the UK many years 7+ following their failing their application claims.

    There is only one way to deal with backlogs and that is overtime, evening surgeries, weekend surgeries, if our surgeons are reluctant to do the overtime then see if Spanish surgeons and their teams want some winter work (at the end of the tourist season) and just get on with it. This extra £750m you’re pumping into the nHS per week is it ring fenced, can it be redirected? The problem with just paying the hospitals whether they perform or not is they can fail without recourse to themselves, in a private company if you don’t do the work, well and on time you don’t get paid.

  29. Elli
    September 16, 2023

    The end game is fast approaching, NHS is taking on more responsibilities than it can afford or handle, civil service is becoming useless, Labour will take the unions into #10.
    Result: a failed state.

  30. Lynn Atkinson
    September 16, 2023

    You will not hear this from the MSM, so I want you to know that:

    ‘On 16 September, the largest protest action in Germany began in Magdeburg’s Cathedral Square.

    Tens of thousands of Germans have already taken to the square to protest against the supply of weapons, the forced vaccination of the population and the “fascist” methods of the WHO and the German government.

    1. Paul cuthbertson
      September 17, 2023

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

  31. mancunius
    September 16, 2023

    ” Why didn’t senior managers in the department take action to tackle it, or alert Ministers and ask for assistance and resource to do so? ”
    Because the cs, and its departmental heads, want this government to be replaced by Labour. And they have little to prevent them from subversive behaviour, as the present government does not have a Mandelson or Campbell to scare the living daylights out of them.

  32. John
    September 17, 2023

    The NHS should be radically devolved. It is in Iceland, a country of under half a million. De-centralisation works (except to top managers who hate the lack of high-paying jobs).

    In Sweden the NHS is mostly run at local government level. I don’t know about Norway, Denmark, Finland; possibly there too. All these systems are tax-funded, much like ours. Nye Bevan made a great mistake when he said it must be run from Whitehall.

    Services which are decentralised become mainly the responsibility of somebody else and reduce the workload of parliamentarians (whose main job should be to stop the executive continuing to become a quasi-dictatorship). National comparisons between districts might be useful though to embarrass the least efficient.

    In my limited experience the NHS is less effective than in 1980. The GP I was with worked from a tiny premises with one partner and one member of staff, did home visits and used paper or card indices. I consulted him only once but got 15 minutes of his time. He explained at length the cause of the problem and how to deal with it. It went away.

    Suggestions over the years for patients to be helped to take more responsibility for their own health and make less use of the NHS have failed. Authoritarian, pharma-led ‘healthcare’ rules. I’m healthy so I’ve de-registered from any GP. I’m not willing to support such a system even via my ‘capitation fee’.

  33. margaret
    September 17, 2023

    GP; our lists are full of minor problems such as ear wax, broken nails, minor allergies which brits would have previously handled by themselves , so just think whilst one of you are trying to get an appointment because you think you may have prostate cancer another might be complaining they cannot get an appointment to see their GP urgently due to hay fever.

    1. a-tracy
      September 18, 2023

      I think this is the root and branch review of who should see patients that has been taking place. Doctors numbers maybe down but nurse practitioners is up, as are other nurse specialists.

      If someone presented to a GP at my practice with any of these things, they would be quickly seen and sent out of the room and told to go to reception and book in with the nurse, although impacted ear wax can make someone deaf. If the patient is unaware of the cause, maybe they caused it using an ear bud is it too bad for a GP to say; “it’s impacted wax ask reception to book you in for an ear irrigation”.

      I can’t believe anyone goes to a GP with a broken nail, maybe an ingrowing toenail, which can be excruciatingly painful. I think any patient, without serious medical conditions, asking to see a GP more than 3 times a year erroneously would probably get marked on the patient record and sent to the NP for triage on any request to see a GP.

      1. margaret
        September 19, 2023

        No! broken nails, not one but a few. My practice does not have ear irrigation. The problem of impacted wax can mask problems with the ear drum . Irrigation involves pushing water into the auditory canal under high pressure and can cause much further damage. I have used this procedure hundreds of times , but thankfully not now.
        In the matter of prevention a low pressure shower which allows water to trickle in the AC and out again can be used (unless there is obvious damage) Because these things have be carried out in the past, it isn’t mandatory that the procedures continue.
        You would not believe the conditions or lack of them which block the lists. I have now been a nurse in absolutely every aspect of medicine and surgery in secondary care and primary care since 1968 .There is very little I have not seen or done. The perception of the public is not keeping up with modern times. I have prescribed as an Independent prescriber since 2005 and make my own decisions . We have a very qualified lead GP who is also a surgeon . He resects many ingrowing toe nails , but don’t presuppose because things happen at your practice it is the same everywhere else.
        It annoys me that a newly qualified Dr gets more respect for a degree course (which is actually completed by his contemporaries on the wards , including many Nurses) than those who continually study, gaining degrees along the way and practice .They often have the answer and the right course of progression or treatment. The Nurse is not a piece worker , there are many Health Care Practitioners who enjoy the certain tasks allotted to them and will become more knowledgeable about the physiology and reasons for completing the tasks in contrast to those who think that they know more.

  34. Margaret
    September 19, 2023

    Triage is over the telephone.Language problems abound.Not just the occasional patient but the majority.Some patients lie to get a urgent appointment ,then use language misunderstandings.English Locums have left due to language problems. I triage,then we get advertisements saying see a Dr when you want if you pay but then the advice to the GP is what any fully qualified Nurse would have done anyway andare left with the investigations.
    Remember the patients arrive from other countries where the common cold is treated with IV antibiotics and different injections for almost everything.They have to pay.Nurses are not treated as a profession and the patients cannot understand the role.
    One German said to me after treating her successfully.”I want to see a proper Dr.They don’t understand that we have our own profession which is growing autonomously.We are not Drs and don’t want to be as our approach is totally different.

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