NHS – front line staff, back office and management


           It is popular amongst many politicians and the public to say we need to spend more on more nurses and doctors, and less on managers and administrators. We need to spend more on medicines and treatments, and less on expensive computer systems.

            This may be true, but it should not go unchallenged. A hospital or doctors’ surgery does need managing. Someone has to make sure there are the right staff doing the right things, that the medical supplies turn up on time, the meals are served and the floors scrubbed. In the 1980s when the NHS was reviewed, the Report concluded that the NHS was then undermanaged.

           Maybe now we have too many managers and too many layers of management. Part of the aim of the current government’s reforms is to simplify and reduce the management overhead, which is a worthy aim.

            A successful hospital also needs good administration with excellent computer records. A nurse or doctor reviewing a patient’s progress, administering continuing treatment or preparing a patient for an operation needs quick and easy access to the patient record. It is important they have the full background so they know what to administer, which treatment to pursue, and what to watch out for.  One of the surprising things in some hospitals is how much is still done manually or with written records after years of high budget spending on computerisation.

          Some hospitals still have handwritten notes at the patient’s bed end. They dispense drugs based on the patient written notes. A proper computerised system would be better at ensuring the right drugs were administered at the right time, as the computer would remember it had already dispensed a given drug, and could check that it was the right drug against a bar code prior to the drug being offered to the patient. Some hospitals I am told now have these properly computerised systems, with the necessary checks against wrongful dispensing or overdosing, and with proper audit trails created by each action in the system.

           Sorting out the balance of work between medical professionals and adminsitrators is part of good management. Nurses and doctors do have to be involved in note making and recording, as it is their judgements which need to inform the system based on the evidence assembled from tests, talks with the patient and visual inspection of the problem.


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  1. Jerry
    Posted July 15, 2013 at 6:13 am | Permalink

    A hospital or doctors’ surgery does need managing. Someone has to make sure there are the right staff doing the right things, that the medical supplies turn up on time, the meals are served and the floors scrubbed.

    Golly-gosh, you don’t say, makes one wonder how hospitals since Miss Nightingale managed before the great NHS reforms of the 1980s. Funny how the senior GP (often whose practice it was) or Matron managed to do all these things without the seemingly unlimited numbers of people in the back office administration – and of course in those days all nurses started their careers learning the basics of bedpans etc, whilst the ward orderlies and cleaners were an integral part of the NHS and not people to be farmed out to private contracts that have been cut to the bone. Pay peanuts, get m…. well you know the saying, and then people wonder why wards went cleansed.

    In the 1980s when the NHS was reviewed, the Report concluded that the NHS was then undermanaged.

    Well that has always been a bone of contention away of the political bubble, “undermanaged” can be code for anything from literally not enough managers to wrongly managed, many argue (and the implement of internal markets at around the same time supports this) that it was actually the latter – thus for these people the debate is about the way it is managed as well as the numbers.

    “A proper computerised system would be better at ensuring the right drugs were administered at the right time, as the computer would remember it had already dispensed a given drug, and could check that it was the right drug against a bar code prior to the drug being offered to the patient.”

    Oh what faith, you know what they say about computers, cr*p in = cr*p out, no computer is better than the data that is input, blind faith in computers is more dangerous than a poorly written record because people in doubt tend to ask whilst errors will get questioned too – also what if the computer system crashes, what then, oh yes, resort to the hand written back-up files…

    Sorting out the balance of work between medical professionals and adminsutrators is part of good management.

    Indeed but not if all it does is find ever more ‘Jobs for the boys’, as seems to be so often the case in any quango based public service, want to know what is happening on the wards, you don’t need countless other departments set up to do endless surveys and invent countless forms for the hard pushed medical staff to fill in, managers just need to get off their -to use a medical phrase- “gluteus maximus”, go down to the wards and have a look around, perhaps ask the odd cleaner, nurse or doctor…

    • Jerry
      Posted July 15, 2013 at 6:16 am | Permalink

      Oops, I meant wards went uncleansed.

    • outsider
      Posted July 15, 2013 at 10:48 am | Permalink

      Dear Jerry, your sarcasm makes the point. The larger the unit, the more managing it needs. Old-fashioned single GPs did not need managers. Small hospitals did not need specialist managers because everyone could talk to everyone else.
      The health economist’s obsession with size misses the point because, roughly speaking, the number of managers needed is squared for any doubling of the size of unit. Vast primary care practices and vast anonymous health factories need exponentially more managers.
      They may be good for other reasons, though probably not. No personal GP means no-one to pilot a patient through a course of treatment through different parts of the NHS and huge hospitals generally have higher rate of hospital acquired infection.

    • uanime5
      Posted July 15, 2013 at 4:07 pm | Permalink

      Part of the problem with nurses is that Labour wanted to save money, so they made nurses perform some of the roles of junior doctors so that they’d need fewer junior doctors. The result was that these nurses didn’t wanted to alternate between performing junior doctors tasks and menial tasks. So healthcare assistants were introduced to perform the menial tasks nurses used to do.

      So if anyone wants nurses to get back to nursing you’ll need to hire more junior doctors.

      • Edward2
        Posted July 15, 2013 at 5:10 pm | Permalink

        You are making it up again Uni. This is not true.
        The only part that is correct is that Labour gave nurses a much more productive and responsible role and delegated the menial tasks such as cleaning and making beds to less well paid and less qualified general staff.
        A sensible division of labour in my opinion.

        • uanime5
          Posted July 16, 2013 at 3:06 pm | Permalink

          Care to explain why nurses are now doing things, such as cannulation and venepuncture, which used to be performed by junior doctors. Face it nurses have been give jobs that junior doctors used to do because nurses get paid less per hour.


          According to the BMJ nurses have been taking over a doctor’s role since 1996. So it seems that Labour is not entirely to blame for this.


          • Edward2
            Posted July 17, 2013 at 8:30 am | Permalink

            Because Uni, of the uprating of the role of nurses which has been happening for many years now under Governments of both colours
            Plans are to make it a graduate entry career.
            PS fitting an IV drip is something nurses have been doing for many years along with student and junior doctors.

          • margaret brandreth-j
            Posted July 18, 2013 at 11:07 am | Permalink

            I actually trained to take blood and cannulate people in 1970. Where do you get your facts from? I took arterial blood and demonstrated it to junior doctors in the 90’s. Actually many Auxilliary nurses take blood. This is a simple procedure which need dexterity and a little knowledge. Actually infusing something from the outside into the circulation needs more skill and knowledge. Knowing what blood and what investigations are required according to changing physiological conditions requires the nurses expertise.

      • Lindsay McDougall
        Posted July 19, 2013 at 12:18 am | Permalink

        Not entirely. You could allow junior doctors to work longer hours, unencumbered by the EU working time directive. The male ones at least are anxious to do so, in order to better themselves rapidly.

    • margaret brandreth-j
      Posted July 15, 2013 at 5:45 pm | Permalink

      Actually I started as a student nurse in 1968 and we were taught the basics of medicine , surgery , paediatrics, psychiatry, obstetrics, physiology , chemistry , by learning the diseases, physiology and appropriate medication, side effects and suitable monitoring processes. This was from Day 1.It is a myth that we were only taught how to give bedpans. We engaged as students in all processes as we were being trained to manage wards and patients. There were state registered nurses , state enrolled nurses( the bedside nurses) auxillary nurses and orderlies. In fact we had state final exams and hospital exams and I had to name the’ Circle of Willis’ , undertake a neurological exam and talk about 3 classes of drugs and what they were used for. This was only one of the exams.
      We all were then undermined as they tried to make nurses all the same and they refused to employ us and let us use our knowledge. If we were on ad hoc shifts and we stopped some grave problem , they got rid of us. Get the picture!
      I have aided junior doctors and had to say to these doctors , as new rules came in “Yes, I will do it for you as long as you say it was you” to enable clinical running to continue.
      There has been a long process in gradually pulling the NHS down and the management and people who want it to be private have ignored the challenges experienced nurse and doctors have made to give warnings. This great organisation will not be damned by the meddling of snooty , class conscious despots who want profit.

      • alan jutson
        Posted July 16, 2013 at 1:25 pm | Permalink


        Many more older and experienced Nurses say on the job training of years past gave better results, because all Nurses where more rounded in general medical and care knowledge in treating and looking after patients, than the university graduates of recent years.

        Do you agree ?.

        If so, then is it not time to reverse the trend back to include training on the job.

        • margaret brandreth-j
          Posted July 16, 2013 at 5:25 pm | Permalink

          Not totally, many of the students are still learning on the job. Proving academic ability is important today as it was yesterday when I trained. The labels differ . What represents academic learning / theoretical training? What is included in the curriculum? I undertook modules in those days , the one that springs to mind is different types of anaemia , as I still have the text. This was a high standard. It is a combination of academic , emotional, clinical, analytic etc skills. As a young student I was thrown into everything as a shy girl and came out the other end as a much more capable person. I would not wish 100 hrs / week, taking charge of wards at 19 , fitting in theory and applying it to practice for any other. It was a continual need to learn at a lightening pace, as we were dealing with lives, but I lost 3 stone and many of my colleagues had breakdowns.

          • alan jutson
            Posted July 17, 2013 at 8:02 am | Permalink


            Thanks for the reply.

            The reason I asked the question because as an indentured apprentice engineer some 50 years ago we also did structured on the job training, combined with day release and night school at tech college, and this combination, turned out (in my view) much better, more grounded and clear thinking engineers at a younger age, than many who simply went to university to learn theory, but had absolutely no practical skills at all.

  2. lifelogic
    Posted July 15, 2013 at 6:20 am | Permalink

    Indeed and it would also help if they could get rid of useless staff more easily (indeed it would benefit all businesses and government). Also if they did not have to deal with all the absurd litigation culture and could actually be honest with relatives when things have gone wrong. This mainly so lessons can be learned to prevent future recurrence. The UK is heading for the absurd US litigation systems with perhaps five times as many lawyers as are actually needed for an efficient legal system that serves the public rather than the profession.

    Get the payments, incentives and rewards right so the hospitals, doctors and other centres who are doing the right things are rewarded. Currently the incentives are often absurd. Rationing by inconvenience and delay is often the order of the day. Make people pay something and get feedback from patients to find out what they thought of the service and how it could be improved, it is useful information. But most hospital have little incentive to improve as they often then get more patients, but without the funding to deal with them.

    • matthu
      Posted July 15, 2013 at 11:39 am | Permalink

      It seems to me that NHS “free at the point of delivery” should entitle you only to best endeavours with no option to sue if anything goes wrong. (Of course there would be nothing to prevent criminal prosecution in the event of gross dereliction of duty.)

      If you want the option to sue, then that should entail paying an additional premium to cover litigation expenses.

      In fact, thinking about it more, the same principle should extend to all activities in the UK. Especially the free ones like playing with conkers or rolling a giant cheese down a hill: no opportunity to sue anyone else if anything goes wrong.

      See how much we could rectify in this country with just plain common sense.

    • uanime5
      Posted July 15, 2013 at 4:10 pm | Permalink

      Given how long it takes to train medical staff and the current staff shortages easy hire and fire is unlikely to benefit any hospitals.

      The Government tried using the reward system and the result was Mid Stafford, which neglected patient care so that they’d meet Government targets and be eligible for all the Government’s rewards.

      • lifelogic
        Posted July 15, 2013 at 7:31 pm | Permalink

        You think they should allow incompetent staff to keep killing patients rather than firing them do you? It does not have to take that long to train medical staff you could just train them in the area needed. So you could have (for example) cataract specialists and similar without them needing ten year training in livers, kidneys, hearts and similar. But the profession’s union would doubtless object, they should be ignored.

        “The Government tried using the reward system” clearly under Labour they were as usual rewarding the wrong things such as putting people on so called “The Liverpool care pathway”.

        • Jerry
          Posted July 16, 2013 at 7:04 am | Permalink

          @Lifelogic: Dentists (for example) do not leant the entire bodies nervous system or how and why kidneys and livers work etc. etc, a dentist not knowing might actually be a very quick way of killing the patients – far from getting rid of incompetence your idea would likely be inducing whole swaths of it not seen since before Miss Nightingale!… 🙁

        • uanime5
          Posted July 16, 2013 at 3:17 pm | Permalink

          You think they should allow incompetent staff to keep killing patients rather than firing them do you?

          According to the report on Mid Stafford patients were dying because the management was trying to keep their budget low by ensuring the the hospital was understaffed and that the staff were overworked. So how exactly would firing the staff fix this problem?

          It does not have to take that long to train medical staff you could just train them in the area needed. So you could have (for example) cataract specialists and similar without them needing ten year training in livers, kidneys, hearts and similar.

          Your post indicates that you know nothing about how medical treatment works. You need to spend years teaching doctors how to do everything because that’s the type of doctor that hospitals and GP surgeries need. As a patient can come in with any medical condition or injury you need a doctor that can treat any such condition or injury. A doctor who only has experience in a narrow field is useless.

          “The Government tried using the reward system” clearly under Labour they were as usual rewarding the wrong things such as putting people on so called “The Liverpool care pathway”.

          The rewards were for being underbudget, so if that’s the wrong thing then there’s very little that can be rewarded.

        • Bazman
          Posted July 16, 2013 at 6:59 pm | Permalink

          It has been pointed out to you before that the treatment of a fit 18 year old man would be different to the treatment of an 80 year old woman. This idea that you are treating people like car servicing is another one of your regressive fantasies. Dentists are more trade like hairdressing then medical people and we know the fun and games this brings. Lowering the bar on more serious treatments is not real. You think the human body is separate systems like in a machine? What planet are you on? Even this is not true in a car with one failure leading to others. A simple one being the engines cooling system. The idea that t’ union is holding medicine back is just stupid.

    • margaret brandreth-j
      Posted July 16, 2013 at 7:00 am | Permalink

      Perhaps if they included all professions in the running of private and NHS hospitals then we would not continually hear , ‘doctors say this’ , or ‘doctors say that’ when actually it is the occupational health team , the physiotherapist , the pharmacist, the nurse, the dietician… but then of course when it comes to private treatment it is the one and only who get the thousands as they continue to claim that they do it all themselves , whilst in the main ,they take from everyone else.

      • margaret brandreth-j
        Posted July 16, 2013 at 9:10 am | Permalink

        I mean occupational therapy of course, then to add ,the lab staff ,scientists, the researchers , the medical devices technicians, nuclear devices etc

      • KH
        Posted July 16, 2013 at 3:41 pm | Permalink

        That’s an enormous chip on your shoulder Brandreth. Most of the good medical care is provided by doctors, that’s why you pay them when you go private. Get over it.

        • margaret brandreth-j
          Posted July 16, 2013 at 6:09 pm | Permalink

          The chip is indeed the lack of recognition by the fantastic work and learning that all professions contribute and it is you that needs to open your eyes . Grow with the times not with the old professional strata of 100 years ago.

        • margaret brandreth-j
          Posted July 16, 2013 at 6:33 pm | Permalink

          I note that you are the second person on this hosted site to resort to a personal insult when my views are expressed, which you do not agree with . This is not going to improve patient care. It is inflammatory and takes the argument away from the problem.

  3. Andyvan
    Posted July 15, 2013 at 6:36 am | Permalink

    Why is it a shock that the NHS is rubbish? Every single instance of any service or business that has been run by government has proved beyond all reasonable doubt that quality, value and efficiency will decline and no matter how much money is squandered in the attempt to improve them it will not work. If you must have public sector health care then do it with a government sponsored insurance scheme and privately run hospitals (no not like the US, that is a nightmare). At least that would be an improvement to the car crash we currently endure. For the best possible system privatize the lot. Deregulate and let the market bring costs down to an affordable level and produce workable insurance that everyone can afford. We’re injecting vast sums of cash into the NHS and kidding ourselves that we’re getting free health care but we’re not. The costs are very real and are dragging us down. It just isn’t obvious to the man on the street yet but as death rates rise along with taxes to pay for it soon you just won’t be able to ignore it.

    • Nina Andreeva
      Posted July 15, 2013 at 9:30 am | Permalink

      Erm I presume you did look at Goldman Sachs research on the cost of an appendicectomy yesterday? How is the NHS so ineffecient? Here is another titbit from The Economist on comparative health care costs. Where are your facts and figures to justify your claims? Presumabley A&E in the NHS is rubbish too and you have your own private provision for when you prang your motor on the M1?


      • libertarian
        Posted July 15, 2013 at 6:47 pm | Permalink


        I suggest you take your own advice an do a bit of research . How do you think the 17 countries above us in the W.H.O ranking of effective health provision manage to provide A&E and indeed clinics and other services far superior to the clapped out NHS?

        • uanime5
          Posted July 16, 2013 at 3:19 pm | Permalink

          Well these countries do spend a larger percentage of their GDP on healthcare.

      • alan jutson
        Posted July 16, 2013 at 1:36 pm | Permalink


        When I had a minor traffic accident in the UK 1964 and was taken to hospital just for a check up, I had to pay the sum of £1.50 (£1. 10 shillings then) for that check up, which was half of my weekly earnings as an apprentice at that time.

        When I asked why I had to pay, they simply said, claim it from your own vehicle insurer, which I found out was true, although I never did.

        Think it was covered by a part called personal accident liability or something similar at the time.

        Do we charge for such treatment now. ?

        If not, why not ?

    • Mike Wilson
      Posted July 15, 2013 at 10:01 am | Permalink

      @Andyvan ‘Deregulate and let the market bring costs down to an affordable level and produce workable insurance that everyone can afford.’

      That made me chuckle. Like the legal system perhaps?

      • libertarian
        Posted July 15, 2013 at 6:49 pm | Permalink


        did you chuckle when you read how they manage it in France, or Italy or Singapore or Germany or indeed in all of the 17 countries above us in W.H.O rankings of effective health care provision

        • Jerry
          Posted July 16, 2013 at 7:12 am | Permalink

          @libertarian: You seem to fail to understand that those countries are more “NHS” than the UK is now, it is became the NHS has done what the free market pushers wanted that we are now 18th on the W.H.O ranking list…

    • Jerry
      Posted July 15, 2013 at 5:24 pm | Permalink

      @Andyvan: The state/government doesn’t run the NHS these days, it merely funds it, but I agree, the current semi privatised NHS is not fit for purpose, the NHS never used to be this bad, it has been the attempt to bring the market into the NHS that has failed. The last thing we need is more privatisation, even if it is contracted out.

    • Bazman
      Posted July 16, 2013 at 7:03 pm | Permalink

      You don’t just cut service reward managers and make the whole thing top heavy and then blame the NHS for failure. How about blaming the patients as this is where business put the blame when they are finished?

  4. Roy Grainger
    Posted July 15, 2013 at 6:57 am | Permalink

    I think our doctors (GPs in particular) get paid enough, compared to European counterparts they are very highly paid.

    Buying single monolithic computerised systems has of course been a disaster for the NHS with billions wasted. I guess the approach should be to allow different parts of the HNS to buy or develop their own systems and then with this competition one or more “standard” systems may eventually emerge.

    • margaret brandreth-j
      Posted July 15, 2013 at 6:20 pm | Permalink

      I don’t know much at all about computer technology; I scrape through, I use it for every aspect of general practice and think it is amazing progress , yet on the district, it does not work . I have only worked on the district? P/T for 5 years. The amount of very basic paper care plans in the community is fatuous , not giving you any pertinent information about patients. Conversely the amount of computer work has changed and we have to duplicate using a computer, claim for travelling expenses , (where we can use £10/ in an evening), use something called Lorenzo keeping data about patients and do on line courses. These computer acrobats have to be done in a time previously used for patients and take up to one hour out of patient time. Thy break down nearly every week and if staff take annual leave , the password has bound to have changed and takes at least a fortnight to get right. There is never any one around to put it right immediately , the report needing to be logged , given a number , sent to someone else , to come back to us to ask us the nature problem, which will be fixed next week when so and so comes of annual leave. It is lack of discretion that many organisations face. The amount of ‘blanket speak’ may be good for managers , but all situations and people are individuals. Why can’t they get it?

    • Roger
      Posted July 15, 2013 at 9:13 pm | Permalink

      The appropriate comparison should be with other Anglophone countries as our GPs are leaving in their droves to these countries or taking early retirement. If Obama’s healthcare reforms ever come to fruition then the US will need many English speaking general practitioners. The market cuts both ways if pay freezes continue

  5. Denis Cooper
    Posted July 15, 2013 at 7:37 am | Permalink

    Off topic, I’m looking at the motions and proposed amendments for this afternoon’s debates on opting out of the EU police and criminal justice measures and the opting back in to some of them including the EU Arrest Warrant:


    and none of it makes happy reading.

    • Hope
      Posted July 15, 2013 at 5:41 pm | Permalink

      The Olympic opening approved by Cameron boasting about the NHS! Three years on and what change has happened from his top down change? The person in charge, and ultimately responsible, is still there! Economy is worse, spending up, taxes up despite promises for change.

      I hope every one will remember that opting in the European arrest warrant is a choice by Cameron. This should start the referendum lock as it is giving a substantial power away to the EU ie people arrested for offences that do not exist here.

      Many people will also remember Cameron for his dictatorial role in gay marriage passing through the Lords today. They will also remember each month their expensive energy bills through green idealogical stupidity.

  6. Nick
    Posted July 15, 2013 at 7:40 am | Permalink

    You need to spend more money compenstating the victims slaughtered by the NHS.

    13 trusts, 14,000 deaths a year.

    Now scale that up to all trusts.

    • Mark
      Posted July 15, 2013 at 11:55 am | Permalink

      I think it would help if compensation claims were limited in respect of such items as loss of earnings and other non-medical aspects: you don’t hurt more because you are rich. Those who consider themselves to be worth more than the ceiling should take out additional insurance to cover the excess, paying out on the basis of the assessment of the claim with no further legal process. Then less NHS money would be spent on lawyers, and more claims would be honoured.

    • uanime5
      Posted July 15, 2013 at 4:14 pm | Permalink

      How many people who died were as a result of neglect, and how many died because they were very old or had a life threatening disease? It’s likely that the ICU (intensive care unit) has a higher death rate than most hospital wards but it’s not because of neglect but because they’re treating people with very severe illnesses.

      • Edward2
        Posted July 15, 2013 at 5:14 pm | Permalink

        Wrong again Uni
        The figure are for the number of deaths which are above expectations.
        The statistics are carefully developed allowing for age of the patient and the level of illness or injury on admission and are based on numbers developed in hospitals from all over the country over many years.

        • Roger
          Posted July 15, 2013 at 9:14 pm | Permalink

          so how many hospital death rates were below expectation ie how many lives were saved ?

  7. Iain Gill
    Posted July 15, 2013 at 7:48 am | Permalink

    Much sense in what you say. But in IT and management what the NHS needs is responsiveness to what the local patients need and want. The problem with the Blair attempt at NHS IT was that it was top down imposition from the centre. You are better off and more likely to succeed if you have small business units making their own decisions on IT and making their own priority calls. But those small business units need to be pressured by empowered patients able to take their business elsewhere to optimise. I note many of the folk who endorsed Blairs NHS IT nonsense in the British Computer Society, Medical Colleges, and so on are still high ranking folk despite having got it so spectacularly wrong, if they had been leader so small business units that go it wrong their failure would be more obvious and they would have been kicked out long ago.

  8. Old Albion
    Posted July 15, 2013 at 7:49 am | Permalink

    Which NHS are you referring too?

  9. a-tracy
    Posted July 15, 2013 at 8:19 am | Permalink

    If I were Jeremy Hunt I’d investigate the Management teams starting with one hospital, how many of the senior administration staff are Operations Management qualified, what are their earnings compared to a senior nurse and are they similarly qualified in their field? How many of them are nursing staff that have transferred over to Administration Management without adequate training and further inspection on their progress, who is in charge of monitoring their budget ability, staff rotation management, over stocking, errors on their wards etc.

    Instead of trying to look at the whole at once I would break the task down. I personally think that Jeremy Hunt is the best MP in this role for a long while, Andrew Lawnsley and his predecessors were too interested in the producers interest rather than the patients interests and I was pleased to read that Jeremy is doing work experience on the job in several roles in the NHS every week at the moment. Get right down into the kitchens and cleaning teams Jeremy please.

  10. Terry
    Posted July 15, 2013 at 8:30 am | Permalink

    Surely, the question has to be, “How did the NHS survive all those years ago without these additional managers”?

    Wretched Brown and Blair conjured up new jobs within the public sector to claim that they had put 1 millions back into work. Yet none of them contributed to UK output. Out of a total workforce of 29 millions, the Public Sector now employs around 6 millions out of which, 1,300,000 work within the NHS. With a population around 60 millions that equates to a Public Sector worker for every 10 men, women and children in the country. And an NHS worker for every 46 inhabitants of the UK.
    Does this figure not sound alarming to you?
    Now, I wonder how those figures compare with other Countries around the world.
    Sweden, for example, has an NHS – what are their comparable figures? Ditto Canada and Spain, et al.

    Something has gone drastically wrong with our NHS as it has become a immense drain on our resources. It is the largest single employer in Europe and just trails behind the Chinese Army (2.3M) and the Indian National Railways (1.4M) and both of these countries have populations exceeding 1,000,000,000 – 20 times the UK.

    How can such a high number of employees be justified within the NHS? It is clear it has grown far too much, trying to treat the world at large and has morphed into a political football, far beyond the modest requirements of its creator, Anauren Bevan.
    Adopting the approaches to “free” treatment of say, Sweden, would reduce the burden quite dramatically. So why aren’t we doing it?
    Fear that’s why. Fear of upsetting the electorate lest they vote out the “Decimators of OUR NHS”!!

    UK Government, grow some and save your country.

    • Jerry
      Posted July 16, 2013 at 3:11 pm | Permalink

      @Terry: The (miss-)management teams started well before Blair/Brown era, NHS Trusts pre date the Labour government of 1997, you might be getting confused with “Strategic health authorities” that were a Labour addition to the NHS Trusts, made in an attempt to sort out some of the issues surrounding the original Trusts – but indeed to their (Labours) shame they didn’t just scrap the problematic and faux internal markets etc.

      You also seem to forget that the NHS never used to be as bad as it is today, at one time countries like Sweden used to look to the NHS, as I’ve said before William Beveridge [1] must be spinning in his grave to see what the political paymasters have done to his creation…

      [1] and perhaps even Churchill, both left and right seem to forget all to quickly that it was a Tory member of parliament, the Prime Minister no less, who was a prime mover in creating the NHS

    • uanime5
      Posted July 16, 2013 at 3:37 pm | Permalink

      The NHS is the largest employer because it employs everyone who works in hospitals in the UK. By contrast in other countries their hospitals are owned by a host of private companies, so only by comparing the number of healthcare worker per capita can you have an accurate comparison.

      Here’s how the number of doctors in the UK compares to other countries:
      UK: 2.2 per 1,000 people
      US: 2.3 per 1,000 people
      Denmark: 2.9 per 1,000 people
      Sweden: 3.3 per 1,000 people
      France: 3.37 per 1,000 people
      Israel: 3.82 per 1,000 people
      Russia: 4.25 per 1,000 people
      San Marino: 47.35 per 1,000 people

      So it seems that the UK doesn’t have too many doctors but too few. We’d also need to increase the number of doctors by a third to adopt the Swedish model.

      • Edward2
        Posted July 16, 2013 at 9:12 pm | Permalink

        Apart Uni, from the very odd statistical aberration of San Marino, I would suggest these figures are due to the size of the population versus the area of each nation and how that population is spread out in the nation.
        In other words you need more Doctors if the population is spread out widely over a larger land mass.
        Sweden falls into this example with a small population but a large land mass.
        It does not warrant the conclusion you have suggested.

        • Jerry
          Posted July 17, 2013 at 2:48 pm | Permalink

          @Edward2: “In other words you need more Doctors if the population is spread out widely over a larger land mass.

          Anyone know what the doctor to patient ratio is for Australia and Brazil?…

          • margaret brandreth-j
            Posted July 18, 2013 at 3:26 pm | Permalink

            Put clinical staff in places without medication, diagnostic labs, scans, clean water, infusions, and simple kit and examination aids like scopes and they are rendered almost useless.

  11. English Pensioner
    Posted July 15, 2013 at 8:56 am | Permalink

    If two businesses merge, the management usually manages to almost halve the overall administrative staff that you have mentioned whilst keeping those carrying out the core business at their existing levels.
    With the NHS (and any government-run activity) the reverse applies. Two local hospitals “merge” (they are 15 miles apart) and as a result patient facilities are closed to avoid duplication (including A&E), and medical staff reduced, but there is no signs of the remaining facilities being increased to cope with the extra demand.
    Meanwhile on the administrative side staff have been assured that there will be no redundancies, indeed there seem to be extra posts at higher level to “ensure conformity of practice” and “inter-site liaison”, etc.. What was a ward is now apparently being converted to offices.
    Would any private company behave like this? I’m beginning to believe that privatisation of the whole NHS is the only solution.

  12. backofanenvelope
    Posted July 15, 2013 at 9:05 am | Permalink

    I see that Prof. Jarman in yet another report says that the problems of the NHS are made worse by the fact that the government both owns and regulates the NHS. The chances of an independent regulator seem unlikely, so lets do the other thing. Break it up and privatise it. The government could then concentrate on policing the medical services.

  13. MickC
    Posted July 15, 2013 at 9:17 am | Permalink

    The proof of this pudding is most definitely in the eating!

    More managers and yet more people needlessly dying in squalid conditions?

    One hardly needs watertight ecivdence to realise there is a causative link, surely?

    The laugh is that this government is about to do exactly the same to the criminal legal aid system. It’ll be big-but bloody useless!

    Double G4S’s all round!

    • uanime5
      Posted July 16, 2013 at 3:39 pm | Permalink

      Would this be the same G4S that failed to provide enough security staff for the Olympics and is currently being investigated for charging the UK for tagging prisoners who were dead, abroad, or in prison?

      • Bazman
        Posted July 16, 2013 at 7:08 pm | Permalink

        The very same and no doubt as effective as Atos.

    • Jerry
      Posted July 17, 2013 at 2:52 pm | Permalink

      @MikeC: “The laugh is that this government is about to do exactly the same to the criminal legal aid system. It’ll be big-but bloody useless!

      The cynic in me says that might be the whole idea…

  14. Acorn
    Posted July 15, 2013 at 9:24 am | Permalink

    Good idea JR. There is a system existing in the NHS and EU (oops sorry to mention) called Near Field Communication (NFC). It is Wi-Fi Lite technology . Your bus pass has probably got it, you wave it within a few centimeters of a reader by the ticket machine. For the techies. The is a car toll booth system that uses GPS to switch on an “app” on your smart phone. The phone has an NFC chip stuck to the back of it to communicate with the phone. the NFC chip communicates with the toll booth with RFID Tx/Rx, positioned on the gantry as you approach the toll booth. It debits your account.

    Some promotion blurb:- “To keep track of patients, their previous treatments, and their prescribed medications, hospitals are incorporating near field communication technology into their medical technology systems. By carrying a smartphone or other device with them, nurses can track how long they spent with a patient and what medications or treatments they administered simply by swiping the phone over an NFC reader designed to record that information and transfer it into the system. This prevents lost paperwork or inaccurate time records. The smartphones can also be used when a nurse works outside a hospital, such as caring for patients on assisted living.”

    • Jerry
      Posted July 16, 2013 at 3:26 pm | Permalink

      @Acorn: Many people are objecting and attempting to live without “Big Brother” and what if the smart card is lost/stolen, for example what stops someone finding/stealing a TfL Oyster card from stealing someone else’s money, now just think of the risks that could be posed if highly personal information might be divulged simply because someone has waved such a card about is a NHS situation, what if such cards get swapped accidentally or deliberately, the wrong drug can be more lethal than no drug at all or the wrong dose – us a PIN with it I hear people should, but what if the person is suffering dementia?…

      Blind faith is technology should be a criminal offence, it can be a killer, indeed aircraft have crashed due to it!

  15. Peter Stroud
    Posted July 15, 2013 at 10:24 am | Permalink

    One area of governmet’s relationship with the NHS, and similar public sector bodies, is staff contracts. Especially those that were drafted by Labour. The ridiculous GP contract that awarded higher pay for less work, and excused GP s from out of hours duty, is a well known example. But how many more contracts did Labour and the public service unions stitch up at great expense to the taxpayer?

  16. waramess
    Posted July 15, 2013 at 11:44 am | Permalink

    This piece just goes to show how absolutely broken the NHS is.

    When politicians need to discuss the failings of an enterprise and constantly seek to change it then it is clear it is beyond redemption.

    How often have we seen an essay on the shortcomings of Tesco or Morrison? They provide an equally important service but the only attention they need is to ensure they operate in a totally competitive environment.

    How often do we see an essay on the managment or failings of Pharmaceutical companies except that the customers think they charge too much?

    The politicians must one day wake up to the inevitable conclusion that they are not competent enough to fix the problem. They will happily spend our money trying to do so for that is what politicians do but they will fail.

    Over 50 percent of GDP and still they are not happy. The Socialists want to start up a construction company and the Tories want to run a high speed railway.

    Maybe the watershed will come soon after the government are consuming materally more than 50 percent and, materially less than 50 percent of the population can be bothered to vote.

    • Jerry
      Posted July 16, 2013 at 3:40 pm | Permalink

      @waramess: “How often have we seen an essay on the shortcomings of [supermarkets] [1] ?

      You need to talk to a few farmers, especially diary ones, then you need to talk to the other supermarket suppliers, yes indeed the supermarkets try and keep the customer sweet but even then -once you start scratching below the very thin French Polish- you soon find issues were ‘bargains’ are nothing of the sort, trying, and more often than not succeeding, to fool the causal/busy shopper by moving the faux offer away from similar products that would otherwise give the game away.

      [1] I have removed company names because I did not want my comments to be mistaken for criticisms of any particular company

  17. Roy Grainger
    Posted July 15, 2013 at 12:27 pm | Permalink

    One interesting thing about the NHS is that it is significantly cheaper than the health services in several of our European neighbours – of course it also has worse death rates – so you get what you pay for. So the aim should be to spend money – possibly more money – on it but more effectively than at present.

    For those advocating the introduction of competition and choice into hospital care as a means of improving it I’d point out that, based on the German experience, this would bring some benefits but has some downside too, such as hospitals covering-up issues like MRSA infections in order not to damage their income, and carrying out more complicated and expensive procedures when not strictly necessary.

    • uanime5
      Posted July 16, 2013 at 3:42 pm | Permalink

      In the past patients did have a choice which hospital they went to. However several Governments decided to save money by closing down local hospitals and forcing everyone to go to a central hospital. So they went from having a choice to having no choice.

  18. uanime5
    Posted July 15, 2013 at 4:33 pm | Permalink

    Perhaps the Government should examine which hospital IT systems work the best and try to implement them in all NHS hospitals. Though this will be expensive as it will require a lot of new computers and staff will need to be trained to use them.

    In other news Iain Duncan Smith’s welfare cap comes into force today. Despite no evidence that it has gotten anyone into work (according to the UK Statistics Authority), and reports that it’s increased homelessness and forced people out of the trial areas it’s being implemented throughout the UK. I predict the following will happen.

    1) The unemployed, part time workers, and couples where only one partner works will be ethnically cleansed from the more expensive parts of the UK as they’ll no longer receive enough money to afford private sector rents. Remember if you don’t work enough to qualify for Working Tax Credits (30 hours per week) you’re still subject to the benefit cap.

    2) A huge number of couples will separate because the benefit limit is £350 per week for single people and £500 per week for couples. So they’ll both by £100 better off per week being single. They also won’t be penalised if only one of them works.

    3) Once the majority of people who used to work in low paid jobs have been removed companies will wonder why they can’t find any staff to work in these low paid jobs. However they’ll be unable to attract any of the unemployed people from the cheaper areas because the cost of travelling to the expensive areas means that working is no longer financially viable.

    The end result is that the UK ends up with high unemployment, while having a huge number of jobs that no one is able to work in.

    • Edward2
      Posted July 16, 2013 at 8:31 am | Permalink

      You do talk some rubbish Uni…”ethnic cleansing”
      In your strange world it seems only those on benefits should always be able to to afford to live in areas too expensive for most of us who work.
      Many millions of people work in city centres all across the UK, but have to commute in from cheaper areas.
      It may come as a shock to you Uni but for us taxpayers this has been the norm for decades.

      • uanime5
        Posted July 16, 2013 at 3:47 pm | Permalink

        Those who have lived in an area all their lives should not be forced into another area because the Government has decided that they’re not good enough to live in this area. Especially if they’re working part time.

        This may surprise you Edward2 but people who commute great distances to work are getting more than minimum wage. So my point still stands that no one will commute a long distance for a job that pays as little as possible. So expect there to be a lot of low paying jobs in high cost areas that no one can afford to work in.

        • Edward2
          Posted July 16, 2013 at 9:21 pm | Permalink

          You know exactly what all who commute are paid do you Uni?
          What remarkable knowledge you have.

      • Jerry
        Posted July 16, 2013 at 3:54 pm | Permalink

        @Edward2: Fine, make these benefit scroungers (most of whop are actually receiving in-work benefits) and because they are on low wages, the reason they are on benefits to start with, these people will not be able to afford to commute having moved to a much cheaper part of the country! Then ignorant people like you would soon be complaining that the streets have not been cleaned, that your tube or bus didn’t arrive and if it did that you needed a pair of disposable overalls to keep your best suite clean. U5 might have got a little “emotional” in his language but he has far a better grasp on the realities of life than you do Edward dressed in your freshly dry-cleaned pin stripe suites.

        • Edward2
          Posted July 16, 2013 at 9:16 pm | Permalink

          Jerry watch your manners.
          In your rush to reply to every post on here you are loosing control.
          Your comment “ignorant people like you” is objectionable and well beyond the level of debate this site requires

          • Edward2
            Posted July 16, 2013 at 9:19 pm | Permalink

            The people you use as examples are the very ones who are commuting into the centres of cities.
            Recent polls have shown a remarkable 80% in favour of the housing benefit cap for the reasons I originally mentioned.

          • Jerry
            Posted July 17, 2013 at 8:11 am | Permalink

            @Edward2: “The people you use as examples are the very ones who are commuting into the centres of cities.

            No they are not, they are the people who live in the area people like you commute to, hence why they are claiming housing benefit etc. and why the housing benefit budgets are going out of control – because people like you get feed up with the commute and move into the area, thus forcing up the market rents, house prices or land values.

            Oh and to pick up on your other comment, how else can one describe people who are ignorant of the facts, or should I assume that you know the facts but then choose to be less than economical with them?…

          • Jerry
            Posted July 18, 2013 at 1:46 pm | Permalink

            @Edward2: “Recent polls have shown a remarkable 80% in favour of the housing benefit cap

            There might well be 80% in favour of capping benefits but that just shows that 80% don’t actually understand anything more than what they read in the right wing tabloid press – most likely… For example many people think that the majority of benefit seekers are all unemployed, that most money is lost by the DWP through fraud because that is what the tabloids like us to think, never mind the fact that only 3% of claimants are unemployed whilst fraud only accounts for 0.7% of the welfare budget [source TUC].

          • Edward2
            Posted July 18, 2013 at 3:35 pm | Permalink

            Your replies seem to be claiming that only those who do less well paid jobs live in city centres and don’t commute and that only well paid people commute in from outside the city centre
            Plainly this is not correct.
            If you were to catch a bus or train as I often do, you would see all ages and all types commuting to work early every day.
            Catching a bus or train from 30 mins travel time outside a city centre will only cost a few pounds a day and I know many who do just that to go to do quite low paid jobs.
            Many millions of “people like me”, as you rudely put, it live in the suburbs and travel to their work every day.
            Reality for hard working taxpayers and millions of other “people like me” is to have to live in areas where they can afford to rent or buy a cheaper place for themselves.
            I would love to live in one of the posh expensive areas in the city in which I work but I find I cannot afford to.
            Bear in mind the benefits cap is £26,000 which is equivalent to a working taxpayer having to earn gross over £32000 so not too bad I would say.
            Anyway Jerry, you better get used to the changes because they are happening at last and for me they are many years overdue.

            PS To put the record straight for you Jerry, and so you don’t incorrectly use these and similar labels to insult me again, I neither play golf, nor drive a posh car, nor own a pin stripe suit.

          • Jerry
            Posted July 21, 2013 at 3:40 pm | Permalink

            @Edward2: I’m sorry that such socail problems go over your head, in a way I hope it is because you are lacking the ability to comprehend anything other than your own position in society but fear that it is just simple political and dogmatic blindness – no one more blind than he who care not to see…

  19. DiscoveredJoys
    Posted July 15, 2013 at 7:27 pm | Permalink

    To mangle a metaphor – when a central organisation wants restaurant quality at canteen prices it ends up with canteen quality at restaurant prices. Lack of competition, producer capture, protection of personal fiefdoms, diffusion of responsibility, Parkinson’s Law, management by accounts, and many other unintended consequences in play.

    The Government should set out the basic priorities for health care and then step out of centralised management. Yes there will be problems but the Government must resist the urge to intervene, and allow local action to remedy the situation.

  20. zorro
    Posted July 15, 2013 at 7:51 pm | Permalink

    Off topic, but I see that the TUC has come out with a report on the different types of jobs created in the last 3 years and their relative pay rates. You will recall that we discussed on previous blogs about what type of jobs were being created, but there was a paucity of research available from what I could see………http://www.bbc.co.uk/news/business-23311502

    From the report…..’nearly 80% of the 587,000 net new jobs since June 2010 have been in sectors where the average pay is £7.95 an hour or less. The TUC said people were being forced to take these lower-paid jobs after being made redundant. The highest paid sectors have also seen jobs growth, the union body said.

    Apparently, there have been…..’net jobs growth in areas like computing, for example, which pays an average of £18.40 an hour. But net job creation in middle income jobs stagnated after 2010.’

    The report’s calculations were based on the median wage earned in each respective industrial sector.


    • Jerry
      Posted July 16, 2013 at 3:58 pm | Permalink

      @zorro: …and how many of those £7.95 an hour or less jobs are part-time or on a zero hours contract… 🙁

  21. Terry
    Posted July 16, 2013 at 7:54 am | Permalink

    I spent time researching the data on the NHS only to find my complete piece ‘moderated’ out. There will be no hope for the Tories if they continue to act as the socialist. If they cannot face up to the truth then they are unfit to be in office. Such targeted reducting reminds me of the deadly cover-ups within the NHS that have recently come to light.

  22. Terry
    Posted July 16, 2013 at 10:00 am | Permalink

    Something is apparently very slow on this blog, I suspect within the moderating procedure. Much as I appreciate the thoughts of a skilled, veteran MP and we need more like him, I do wonder if the management of his blog are up to his standards.

    • Jerry
      Posted July 16, 2013 at 4:07 pm | Permalink

      @Terry: Mr Redwood does have a day job you know! He fits in the running of this website between his personal life and professional duties as an MP and that means moderating our comments as he has occasionally explained within his blogs.

      • Edward2
        Posted July 16, 2013 at 9:24 pm | Permalink

        Yes and must spend most of it reading your endless posts Jerry

  23. Chris
    Posted July 16, 2013 at 10:27 am | Permalink

    Camilla Cavendish report is a must read. She was excellent on Newsnight last night as well. Fraser Nelson made valid points that throwing more money at the system did not result in better care.


    • Jerry
      Posted July 16, 2013 at 4:11 pm | Permalink

      @Chris: Indeed, throwing even more money at pyramid building managers will never improve the core health service, although it might improve the office skills of some – the last thing that is needed is more free-market liberalisation, human life is not something that one can put a market value on easily.

  24. Lindsay McDougall
    Posted July 17, 2013 at 1:14 pm | Permalink

    The practical problem is that the condition of a patient can change rapidly, yet a 24/7 hospital system involves three 8 hour shifts each day. The outgoing shift has to communicate by leaving notes at the foot of the patient’s bed. Furthermore, a wise patient will recognise (a) that these notes are often not comprehensive and (b) that he/she will sometimes need to brief the incoming shift. A computerised system is not dynamic enough to deal with this sort of situation, although computerised notes will often be useful if a patient is readmitted to hospital months later.

    During my two short stays in hospital earlier this year, I found that there were plenty of nurses and ancillary staff. It was doctor time that was in short supply. Are junior doctors still constrained by the EU Working Time Directive on the number of hours per week that they can work?

  25. Lindsay McDougall
    Posted July 19, 2013 at 12:39 am | Permalink

    With every passing day, there is more bad news about NHS hospitals. It seems that the Government needs a million inspectors to highlight all the flaws. I know where we could get this army of inspectors from; they are called patients, or customers if the NHS hasn’t entirely forgotten the concept. I also know the environment in which such inspectors would be most effective; it’s called a market.

  • About John Redwood

    John Redwood won a free place at Kent College, Canterbury, and graduated from Magdalen College Oxford. He is a Distinguished fellow of All Souls, Oxford. A businessman by background, he has set up an investment management business, was both executive and non executive chairman of a quoted industrial PLC, and chaired a manufacturing company with factories in Birmingham, Chicago, India and China. He is the MP for Wokingham, first elected in 1987.

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