Memo to an incoming Prime Minister It’s not the amount of money you spend that counts

Sometimes the outgoing government has adopted the Labour approach to public services, defining them by the amount spent. This says if I spend extra on a public service it will be better than if I do not. People are told they should be grateful whatever the actual level of service because a service is so expensive. A Minister faced with a public service problem reaches for the cheque  book when it may need intervention over how the existing money is spent and the service is managed.

When I go shopping I do not seek to maximise the cost of what I buy. I do not automatically assume dearer means better. Sometimes the cheaper shop or the cheaper product is as good or better than the dearer. I make judgements of value, fitness for purpose and cost. So shouldn’t we do the same for the public services we sometimes use? Shouldn’t Ministers on our behalf as taxpayers and public service users be the voice for value for money, for quality and efficiency?

The public sector does contract in quite a lot of service and goods supply from the private sector. This can help the public sector by ensuring competitive tenders for the work to be carried out. The public sector needs to be a well informed customer. It needs to be clear about what it is trying to buy with a proper specification. It needs contracts that do not transfer all the risk of non performance to the state. It should not normally be bankrolling any failure by suppliers, though given the size of orders it may need to assist with start up and working capital.

The NHS does not need another top down management reorganisation. It does need a slimming of senior management and of the quango forest that has grown up around our hospital trusts and GP surgeries. Patients will judge the NHS by how easy it is to get access to diagnosis and care, and by how successful the care and treatment is. They will not judge it by how much it costs.

Before agreeing any sum the Treasury needs to establish exactly how the extra money will be spent, and ensure the base budget is also well directed. In successful organisations staff and cash resources are routinely switched from areas no longer in such demand to new pressure points. There is a need for continuous improvement to boost quality and value for money.

188 Comments

  1. Lifelogic
    July 31, 2022

    Warren Buffett: “Price is what you pay. Value is what you get.” but for government they are spending other people’s money on this for other people so care neither what they pay not what value they get. Much of what they do does positive harm.

    Mike Warburton is right today in the Sunday Telegraph – HMRC must put an end to this witch-hunt. IR35 has become one of the most dangerous pieces of legislation that I can remember.

    Truss should ditch this and her misguided childish plans on wolf whistling. The police do nothing for most burglaries, muggings or thefts so they can do without whistling crimes.

    Reply
    1. Lifelogic
      July 31, 2022

      Other people’s money on “things” for other people I meant!

      Reply
      1. Ian Wragg
        July 31, 2022

        Why has the Navy,s new test craft been built in Holland. Don’t we have any shipyards

        It’s a warship after all.

        Reply
        1. ChrisS
          July 31, 2022

          This isn’t really a warship : it was adapted from an existing design : the Dutch-built Damen 4008 Fast Crew Supply ship. At “only” £20m it’s an insignificant sum and the design was adapted to suit the Navy’s purposes and the ship built in only 12 months. I suspect that to design and build from scratch here in the UK would have taken three to four years and cost at least twice as much.

          Reply
          1. glen cullen
            July 31, 2022

            £20 million…the cost of illegal immigration hotels, or the shortfall of some council budgets or circa 500 police or a faction of what octopus energy is asking in a loan (£1bn)…..spend wisely

        2. Peter Gardner
          August 1, 2022

          It was a Tory, David Cameron, who cancelled warship building in England, in order to curry favour with the Scots.

          Reply
    2. Nottingham Lad Himself
      July 31, 2022

      I could recite yet again the costs to local authorities of being compelled to out source Japanese knotweed suppression to the private sector, who always ensure that there is some left to grow back.

      There are analogous practices across the range of services.

      Reply
      1. Bloke
        July 31, 2022

        Authorities should pay by results.

        Reply
        1. Lifelogic
          July 31, 2022

          Indeed if this so it is incompetent contracting by the LEAs. They should make sure they get the results they want and only pay if/when they do.

          Reply
      2. Peter2
        July 31, 2022

        More nonsense from you NHL.
        The landowner is responsible for dealing with the difficult problem of knotweed.
        There are big penalties if you fail to deal with it correctly and effectively.
        The companies that specialise in this task are also covered by laws if they fail.
        A look on the Internet show several firms that offer an insurance backed100% guarantee of success.
        No company would survive long in this market if they did what you claim.

        Reply
      3. a-tracy
        July 31, 2022

        NLH I don’t believe they leave knotweed to grow again in the same plot, do you have examples of a company that did this? Are they being sued?

        Reply
      4. acorn
        July 31, 2022

        As this is a Civil Service blaming day rather than an EU blaming day, I must stick up for the former.

        Since 2015 there have been forty seven “Ministerial Directions (MD)” that have overridden advice from Departmental Permanent Secretaries (PS). That is half of all MDs issued since 1990 that are known. Permanent Secretaries are the Accounting Officers for their respective Departments and can be called to account by Parliament.

        In the following link, you can see where the Brexit and Covid ministerial directed spending, overruled Civil Service procurement and contract tendering rules; hence making normal auditing of that spending near impossible. This action absolves the PS; the Minister takes over responsibility for the spending which in practice means no publicly accountable responsibility whatsoever. The Chancellor gets the blame automatically.
        https://www.instituteforgovernment.org.uk/printpdf/5263

        Reply
      5. Peter Gardner
        August 1, 2022

        It’s is odd that when I was in public service, my contracts never over ran on time or budget although tat was normal. Part of the problem is that few civil servants know who industry operates so are not good at negotiating and managing contracts. Another part of the problem in local government is straightforward cronyism.
        I suspect that in practice in the specific case of Japanese knotweed, the plant is so vigorous it is simply not practicable to eliminate it and that the most economic option is to suppress to a certain level. But perhaps such subtlety would be beyond the capability of local government.

        Reply
    3. Cuibono
      July 31, 2022

      +many
      They just can’t help themselves in their interfering and meddling.
      No doubt the obsession with wolf whistling has sinister undertones.
      Like some vendetta against romance and marriage?
      Or maybe people who have never been whistled at nor are ever likely to be just don’t understand the nature of such social interaction?
      I always found it most flattering!

      Reply
      1. MFD
        July 31, 2022

        Yes Ian, we have one on our Devon river bank at Appledore, fit to builld large fishery vessels for the Republic of Ireland!
        I guess the backhanders are not enough or we have to still obey EU rules which force who gets what!
        Appledore shipyard by the way built the bulbous bow for HMS Queen Elizabeth so they can compete when allowed.

        Reply
        1. glen cullen
          July 31, 2022

          Agree

          Reply
      2. Fedupsoutherner
        July 31, 2022

        Cuibono. Oh those were the days. It really made my day to get a wolf whistle. I really can’t see the harm in it.

        Reply
        1. cuibono
          July 31, 2022

          +many
          Agree 100%!

          Reply
    4. PeteB
      July 31, 2022

      Spot on lifelogic. The most efficient forn of spending occurs when an individual spends their own money on themself. The least efficient when a group spends other people’s money on other people. Government is entirelty in the second segment.

      Sire J, how about a change of principle in government. Not “how can I spend more money?”, instread “why is Government doing (and paying for) this at all?”.

      Reply
      1. Lifelogic
        July 31, 2022

        +1

        Reply
      2. MFD
        July 31, 2022

        Agreed Peter B 100%

        Reply
    5. Rhoddas
      July 31, 2022

      +1 absolutely spot on. A contractor has a severely reduced contract for temp. Services compared to an employee, no pension, sick pay, paid vacation etc. IR35 treats a contractor for tax as both an employee and employer.. draconian and inequitably wrong. Get rid of it, it started life under Brown and is a socialist policy anyway…

      Reply
      1. Lifelogic
        August 2, 2022

        +1

        Reply
    6. ukretired123
      July 31, 2022

      LL agree on IR35 which has reduced self employed from 5m to 4.2m plus me as a deterrent when modern technology requires going in the completely opposite direction.
      See DT today Lord Forsyth on RS who failed to appear before a committee to explain printing £450 billion was massively inflationary , no vision and no empathy for the small guys (hit by Gordon Brown’s IR35 work deterrent).

      Reply
    7. Richard1
      July 31, 2022

      +1 that is a very silly idea of her’s

      Reply
  2. Lifelogic
    July 31, 2022

    You say:- When I go shopping I do not seek to maximise the cost of what I buy. I do not automatically assume dearer means better. Sometimes the cheaper shop or the cheaper product is as good or better than the dearer. I make judgements of value, fitness for purpose and cost. So shouldn’t we do the same for the public services we sometimes use? Shouldn’t Ministers on our behalf as taxpayers and public service users be the voice for value for money, for quality and efficiency?

    Of course they should do this – but civil servants are spending other people’s money on things for other people they have no incentive at all to deliver value for money. Indeed often the complete reverse as they often seek more power, a larger department and a larger budget, a posher more convenient (for them) office… then we have much corruption and lobbying with vested interest even paid “consultancies” for MPs and Lords. Even when things go badly wrong as they usually do they often benefit with even more money, wages, staff, power to fix the problem they created.

    I note Rishi takes the socialist wording of “asking” people/businesses to pay a little more tax. It is not “asking” Sunak it is demanding with menaces – with a threat of imprisonment and confiscation!

    Rishi irritatingly also seems to user “quicker” as an adverb and uses “amount” for countable things but I suppose so many people do this nowadays.

    Reply
    1. Sir Joe Soap
      July 31, 2022

      I’m coming to the conclusion that Sunak would irritate us unremittingly and Truss would disappoint. Not certain why, just a hunch.

      Reply
      1. Lifelogic
        July 31, 2022

        +1 Truss has a huge amount of problems & delivery that is needed.

        Reply
      2. Mickey Taking
        July 31, 2022

        you mean like the previous 3 PMs? Irritate and disappoint!

        Reply
        1. Lifelogic
          July 31, 2022

          I remember PMs from Wilson/Heath through to Boris. All save Thatcher have been appalling. Even Thatcher made huge errors killing many Grammar schools, not cutting the state back remotely sufficiently, burying us further into the EU, not getting fair competition in health care, education, transport, energy, appointing a foolish John Major without a maths O level as Chancellor and even letting him join the ERM as a precursor to the EURO…

          Perhaps Blair did the most damage with his appalling wars, botched devolution, economic incompetence… I cannot find a single positive that he did in his 10 years. Then again Heath joining the EU on a lie & without voter consent was an appalling error.

          Reply
          1. John Hatfield
            July 31, 2022

            I think error is the wrong word LL. It was intentional deceit.

          2. Peter Gardner
            August 1, 2022

            LifeLogic, perhaps we should get rid of governments. It is true that the more extensive their powers the greater the risk of harm to the citizenry. It is one argument against the EU – it puts 450million at risk rather than a mere 80 million or so. Nature sees strength in diversity. That is why we need many nation states, not power blocks. But how small should states and governments be?

    2. Cuibono
      July 31, 2022

      ++
      Yes!
      That “quicker” is sooo irritating!

      Reply
    3. Jim Whitehead
      July 31, 2022

      LL, +1 to both of your excellent comments.

      Reply
  3. ignoramus
    July 31, 2022

    Disappointed by Liz Truss waxing lyrical about Oxbridge as if it is the answer to life.

    I do not understand this obsession with Oxbridge, which mostly seems to come from alumni – Truss being a Merton girl.

    I am always struck by the telling statistic that 26 of our last 27 prime ministers went to Oxbridge. I think an enormous amount of them also did PPE at Oxford.

    Reply Where you went to uni and what you studied is never an issue in leadership elections. There is no Oxbridge club or conspiracy.

    All seems a little too cosy to me.

    Reply
    1. Sir Joe Soap
      July 31, 2022

      It seems to be more to do with subjects studied. Not a large cohort of Natural Sciences, Maths graduates or Engineers in there I suspect. There seems to be a suspicion that scientists and mathematicians analyse and prove rather than just working on group think and emotion, which is the stock in trade of arts, social sciences.

      Reply
      1. formula57
        July 31, 2022

        @ Sir Joe Soap – note we only know about group think because of the efforts of social scientists.

        Reply
      2. Peter Wood
        July 31, 2022

        I’m reading that Ms Truss is thinking about Mr Kwarteng for Chancellor of E. Given his learning and performance at BEIS, which can charitably called ‘relaxed’, one has to question Ms. Truss’ decision making. There is surely somebody better qualified, with at least some maths and finance learning, for this critical job!
        Sir, J, what do you think?

        Reply
        1. Lifelogic
          July 31, 2022

          Kwarteng is fairly bright and sound but he fell completely for the climate alarmist, expensive, intermittent energy lunacy or perhaps did not but took the job. Often demonstrating his total ignorance of the subject and muttering drivel about hydrogen, storage and being the Saudi Arabia of wind in podcasts and interviews.

          Kemi is sound today in the Times on the dreadful group thing at the Tavistock Clinic.

          Deluded groupthink is everywhere in government however – net zero, climate alarmism, public transport, bikes, walking, trains, good – cars, trucks, planes bad.

          Subsidised hydrogen, wind, solar good fracking, coal, oil, gas bad.
          The state monopoly NHS is the envy of the world.
          The state should have a virtual monopoly on education.
          Ever more people with two Es at A level should spend 3 years at UNI reading grievance studies or similar and getting into £50k of debt.
          Government web sites even quite wrongly claim walking and cycling cause no CO2 and importing wood to burn at Drax is sensible – so moronic are the head people there.

          Reply
      3. Lifelogic
        July 31, 2022

        Indeed both Truss and Sunak read PPE they probably have little or no science beyond O levels or GCSEs. Perhaps why both of them have fallen for the net zero climate alarmist and energy fraud.

        Reply
        1. a-tracy
          July 31, 2022

          Lifelogic did you know Sunak also was a MBA Fulbright Scholar at Stanford, obviously a very good networker, primed for the top not just in the UK by Oxbridge but also well connected. He then became a partner in a hedge fund. The sort of man that must believe he is the cream of the crop, he must have a lot of sway and persuasive methods as he convinced Boris he couldn’t do some of the things he is now saying he will change.

          Reply
      4. Lifelogic
        July 31, 2022

        Indeed very few indeed the Kwasi & Greg Hands at energy are both are quite bright but both read history and neither has a clue about energy. This they regularly demonstrate. Get some decent Cambridge or other engineers in charge.

        Reply
        1. Original Richard
          July 31, 2022

          LL :

          Even worse than Kwasi Kwarteng’s lack of knowledge to be the Secretary of State for Business, Energy and Industrial Strategy, having read classics and history, is the total lack of any formal scientific or engineering knowledge obtained by those at the head of BEIS itself.

          PPE/economics, modern languages and experience in the Department of Health and Social Care is deemed the required qualifications by the Civil Service for the engineering challenge that is Net Zero.

          Reply
    2. Richard1
      July 31, 2022

      I don’t think that can be correct. None of brown, major, Callaghan, Home, Churchill, Chamberlain or Lloyd George did. Can’t remember about the C19th ones

      It’s a pity Liz Truss is banging on about having been at a comprehensive school whereas Rishi went to Winchester. What on Earth does it matter?! No Conservative should play the leftist prolier than thou game.

      Reply
      1. Lifelogic
        July 31, 2022

        Indeed what matters most is sensible policies and implementation. Yet even Truss want to retain climate alarmism, expensive energy and net zero and retain the ECHR. What is really needed is a state sector and taxes half the current level and a vast bonfire or red tape. Real freedom and choice and no rigged markets in energy, healthcare, transport, housing, education…

        Reply
    3. formula57
      July 31, 2022

      @ Ignoramus “…26 of our last 27 prime ministers went to Oxbridge” – this is wrong: the appalling Brown went to Glasgow and the appalling Major omitted to go anywhere. (Most of the Oxbridge ones were appalling too, obviously.)

      Reply
    4. Julian Flood
      July 31, 2022

      Judging from my experience, PPE is not an indicator of political ability – I once heard it described as ‘media studies for toffs’. Prof. Bogdanor has much to answer for.

      JF

      Reply
      1. Lifelogic
        July 31, 2022

        I think of it as a sort upmarket bent second hand car dealer bullshitter course – but then perhaps that is that the skills needed by many politicians nowadays? A few do survive with brains still intact – Anne Widecombe (though she read Classics first, Tony Abbott (economics and Law first), Nigel Lawson (though I think he initially was going to read maths). The problem is perhaps the types of people who aspire to read this course. Wiki has a very depressing list of them.

        Reply
      2. Lifelogic
        July 31, 2022

        A very depressing list with a tiny number of sound people on it.

        https://en.m.wikipedia.org/wiki/List_of_University_of_Oxford_people_with_PPE_degrees

        Reply
    5. ignoramus
      August 2, 2022

      Agreed. I don’t believe there is any Oxbridge club or conspiracy.

      But the numbers don’t lie.

      It cannot be random accident that so many of our PMs have done PPE at Oxford. It seems to imply some form of roadmap to becoming PM.

      I admit it is self-selecting, as anyone who is driven to be PM will do PPE at Oxford, but this in turn will lead political types to bunch together at a very young age.

      Reply
  4. peter
    July 31, 2022

    The whole procurement issue needs fully addressing. I understand there is a limited review being undertaken now. When suppliers have no written criteria it is difficult for those not in the know to compete. Cost is way down the list if the supplier uses woke community staff to source the product! We should return to the comparable cost for the same quality product being the main determining factor.

    Reply
  5. Roy Grainger
    July 31, 2022

    It is clear that the Civil Service is terrible at contracting services from the private sector. You only have to look at projects like Crossrail and HS2 where all cost and schedule overruns end up being paid for by the taxpayer. Public sector contract negotiators must be inexperienced and incompetent whereas I can assure you the private sector equivalents on the other side of the table are the exact opposite – they have to be to make a living. Same story on project management. The best way to improve the situation would be to hire senior private sector people into the Civil Service.

    Reply
    1. Julian Flood
      July 31, 2022

      There has been a disgraceful decision to go ahead with Sizewell C when the delays and cost over-runs on all EPR builds is on public record and there has been an announcement by EDF that the fuel rod distortion and leak at Taishan necessitates a redesign. Even the recommendation of the planning review has been ignored.

      This is not a sunk cost fallacy, it is a sunk political capital fallacy. Saving political face will not keep the lights on.

      Frack now, while the Biden ban on fossil fuel development means there are rigs standing idle above the great Permian gas play. The Eagle Ford play in the US went from zero to half the UK’s total gas production in five years.

      An economy running on our own natural gas-it makes a wonderful fuel for internal combustion engines – is halfway to the hydrogen economy. We could be there in five years.

      JF

      Reply
      1. Stred
        July 31, 2022

        This stupid decision may have something to do with the enormous loan that the UK Green bank made to EDF about ten years ago. There are no engineers at BEIS.

        Reply
        1. Mark
          July 31, 2022

          I think that sabotaging nuclear by pursuing the wrong design is part of the deep green support for unworkable wind. I already know of several submissions to the BEIS Select Committee that criticise the plans for zero carbon generation that they are enquiring into – including my own.

          Reply
      2. Original Richard
        July 31, 2022

        JF :

        Fully agree with you re Sizewell C, fracking and using natural gas for transport, as well as heating, as it can power HGVs whilst batteries cannot.

        But the distribution of hydrogen is far too expensive for transport and even for heating as it cannot use the existing gas network. Far cheaper to produce green methane using cheap nuclear SMRs for both transport and heating if net zero is required.

        The combination of intermittent wind power and electrification of transport and heating is such a poor choice that it must have been made deliberately to ensure we have eventually the rationing of food, energy and travel.

        Reply
        1. anon
          July 31, 2022

          Any new nuclear should be UK owned and controlled. RR or the UK state directly. Other foreign state actor contracts should be allowed to expire or be anulled.

          In the meantime we develop UK gas, storage and use all existing coal plants to the end of there useful lives. Mothballing them rather than destructively removing them as a UK future safety-net.

          Search Electric battery with lighter mini Fuel Cell Hydrogen range extenders.
          ‘UK’s first hydrogen truck’ launches

          Hydrogen can be blended into normal pipes at low levels. Trials continue.

          Green hydrogen is currently expensive but if renewable or other curtailed energy is used then from the UK’s point of view its cheaper than not using it.

          Reply
          1. Original Richard
            July 31, 2022

            anon : “Hydrogen can be blended into normal pipes at low levels. Trials continue.”

            Blending small quantities of hydrogen (10%) is a waste of time and effort.

            100% hydrogen requires 3/3.5 times the volume flow to obtain the same rate of flow of energy as methane/natural gas thus requiring much bigger pumps and hence more distribution energy consumed. Hydrogen corrodes the existing steel pipes used to transport large quantities of natural gas and since it is a small molecule requires far better leak control.

            Far better to produce green methane so the existing gas distribution network and boilers/gas hobs etc. can be used without modification.

            Natural gas can also power cars and HGVs.

            Not only is green hydrogen expensive to produce it is extremely expensive to distribute and has a very low energy density by volume. Far better to develop green liquid hydrocarbons.

        2. Lifelogic
          July 31, 2022

          Seems the government have an insane energy agenda to me and have for many years. Even if you do accept the CO2 devil gas/climate emergency lie it just will not work in practical or CO2 terms.

          Reply
          1. Original Richard
            July 31, 2022

            LL :

            Correct.
            It is not possible to devise a worse syetm than renewable (wind) energy and electrification to eliminate emissions of CO2.

            The collapse of either the current Net Zero Strategy or the country is inevitable.

        3. Original Richard
          August 1, 2022

          PS : Awoke this morning to find wind is producing just 0.45GW, 1.81% of demand out of 27.5 GW installed capacity.

          Reply
    2. Peter Parsons
      July 31, 2022

      But then they would probably expect senior private sector salaries, which the public sector does not offer.

      Reply
  6. David L
    July 31, 2022

    The NHS is rather hamstrung as regards costs. With over-prescription of drugs now routine and expected by patients the huge sums of money being paid to the pharmaceutical industry will continue to escalate. Treatment that is perceived as “free” means there is little incentive to take responsibility for one’s own health. And when you see the number of missed appointments at Wokingham Medical Centre (pre-Covid they had a a chart on the wall there showing the monthly figures, and they were often in the hundreds!) it seems plain that there should be a small charge for seeing the Doctors. But where is the politician who would dare to raise these issues?

    Reply
    1. Mickey Taking
      July 31, 2022

      Where can I see the number of missed appointments? It would be good to know the stats on WMC doctors – their face to face, and telephone ones held. Judging by the empty carpark, and marie celeste inside – not a lot of physical attendance.

      Reply
      1. glen cullen
        July 31, 2022

        Could the government pay the patient £10 every time they attempt but don’t get a next day GP appointment…..and £50 if told to call again tomorrow

        Reply
        1. KB
          July 31, 2022

          And compensate people for the 30-minute phone calls? Paid for by the GP Practice of course.

          Reply
        2. Mark
          July 31, 2022

          It might help if they changed the rules that encourage doctors to retire once they are about 50.

          Reply
    2. SM
      July 31, 2022

      David – a very frail pensioner friend attended a Pain Management Clinic for the first time last week at a major London hospital. Apart from the utter fiasco of giving her conflicting times to appear, and then apparently being incapable of managing the routine for patients who had to have tests in separate areas before treatment, she had serious problems attempting to get on to the treatment bed – a nurse informed her that the beds were newly-purchased but were without the facility to elevate or depress their height. I wonder how that happened?

      Regarding missed appointments – it has been difficult to contact hospital departments by phone for YEARS in my experience, and getting through to GP receptionists appears to be almost impossible nowadays. So if someone living alone falls over and cannot get up, should they be fined for missing an appointment? If your partner or a relative you care for becomes comatose and needs an ambulance to get to A&E, should a missed GP appointment be the first thing on your mind?

      Reply
      1. Lifelogic
        August 2, 2022

        +1

        Reply
  7. Cuibono
    July 31, 2022

    Do ministers feel constrained to spend the entire budget ( and possibly more?) or maybe face a lowered allocation in the next financial year?

    Reply
    1. Donna
      July 31, 2022

      Yes. If you don’t spend your budget allocation, it will be reduced the next year. So the incentive is to spend it ….. and when you get towards year-end, that becomes the priority not the value of the product being purchased.

      Idiotic policies like the 0.7% of GDP to be squandered on foreign aid are even worse since they guarantee an ongoing percentage of GDP regardless of how/where the money is spent and that, in turn, led to money being shovelled at Charity-Quangos without any kind of control over it.

      But it made the virtue-signallers in Parliament happy.

      Reply
      1. Cuibono
        July 31, 2022

        +1
        Agree 100%

        Reply
  8. Gary Megson
    July 31, 2022

    I do understand that you are desperate to avoid the next Election being all about how the twelve (plus) years of Conservative rule are the cause of the NHS’s masive funding crisis, and I know too that you don’t want people to talk about how Brexit has led to so many nurses and care workers leaving the Uk and returning home. I see Ms Truss wants to talk about toilets in schools rather than NHS waiting list. But it’s not to work. Your party is falling to bits, you have no solutions

    Reply
    1. Sir Joe Soap
      July 31, 2022

      Surely thousands have arrived by boat from France to replace the nurses?

      Reply
    2. Richard1
      July 31, 2022

      There are problems with such staff shortages all over the developed world. In The US for example, which has not left the EU. According to the latest data there are 2x as many EU citizens in the U.K. as estimated at the time of the referendum. According to project fear there should be virtually none by now.

      Reply
    3. Dave Andrews
      July 31, 2022

      The problems in the NHS are less to do with Conservative rule and more a failure of the UK population. If hospitals are stuffed with the consequences of lifestyle diseases, more staff are needed and the cost of treatment increases. Once you’ve employed all the most suitable medical staff, what do you do when they don’t meet the need? Do you begin to employ less suitable people, who are more likely to make mistakes or work inefficiently, or do you accept a reduction in care? You have to wait for a nurse to be born, you can’t exchange money to create one.
      I expect the nurses and care workers returning home will be most welcome in their home countries. Why should clinically obese of this country denude other countries of the genuine medical attention they need?

      Reply
      1. Jim Whitehead
        July 31, 2022

        DA, +1. Good valid comment, thank you.

        Reply
      2. Mickey Taking
        July 31, 2022

        It starts and ends with GPs not being able to make correct judgements on possible cancers – for instance. Few patients get seen, they get fobbed off, suffer shocking delays. Finally referred the cancer is now advanced, proving disasterous, even terminal and very expensive to treat. So, is that a failure of Government, broad NHS, or specific doctors?

        Reply
    4. Fedupsoutherner
      July 31, 2022

      Gary. Quite frankly I can see no better alternative unless you count Reform and we all know with the current voting system they won’t get in.

      Reply
      1. Shirley M
        July 31, 2022

        Do they need to win? UKIP (and Farage) won enough votes to shake up the main parties, and forced the biggest political change in my lifetime. We actually had a democratic vote on the EU, for the first time, and we would still be waiting, if it weren’t for Farage and UKIP. Such a shame more UK politicians are not more patriotic or democratic and need to be shamed into listening to the electorate.

        Reply
        1. glen cullen
          July 31, 2022

          Spot On

          Reply
    5. Peter2
      July 31, 2022

      Tell us Gary how much extra would solve the problems of the NHS?

      Reply
      1. glen cullen
        July 31, 2022

        Not money….but maybe making GPs and Consultants Doctors full time employee of the NHS and not self employed, with restrictions of no private work

        Reply
        1. Hat man
          July 31, 2022

          +1

          Reply
        2. Qubus Merrie
          July 31, 2022

          Why not pay GPs according to how many patients that they treat in. Year, rather than the number they have on their lists?

          Reply
    6. Mary M.
      July 31, 2022

      The main reason so many care workers from the EU left the UK was because Health Secretary Sajid Javid brought in a vaccine mandate for them last year.

      Remember his words? “If you work in a care home you are working with some of the most vulnerable people in our country and if you cannot be bothered to go and get vaccinated, then get out and go and get another job.”

      He was also on the point of mandating the vaccine for NHS workers (fortunately having to back-track after Dr. Steve James of King’s College Hospital made it plain that he himself would leave his job rather than comply), hence the flight from the NHS by those who did not want to be forced into accepting a medical procedure not yet past its experimental stage.

      Reply
    7. No Longer Anonymous
      July 31, 2022

      Gary – Record numbers of migrants are allowed here. Including from the EU.

      Reply
  9. Jason
    July 31, 2022

    Yes and when I go shopping I don’t take the bus to the other side of town just because I don’t like the look of my neighbours or they speaK with a foreign accent. I shop locally because it makes sense, it saves on distance and time and eventually cost – also there is the added benefit in knowing who your local trader is because sometimes you can get better cuts and better deals – you know what the traffic bottlenecks are and so it’s easier to get around expecially at holiday times – makes sense – trade with your neighbours and save on the costs – build partnerships join the traders club card deal and get the perks – so now how to transform that into real life?

    Reply
  10. Mark B
    July 31, 2022

    Good morning.

    But it does matter how much money is spent when the service is failing, because the opposition use lack of money excuse to disguise the inefficiency of the unionised service and, so deflect attention away from much needed reform.

    I saw a YT of a union leader stating that there is not enough money being spent on education and, in particular, teachers pay. She demanded that more money should be spent. She did not say where this extra money should come from, eg taxes. But they never do !

    We have been conditioned to look to government and the State to look after us. Even during the Scamdeminc the messaging was to follow government advice when, in truth, I could simply make my own decisions and determine the risk both to myself and to others.

    I am still here, fit and healthy and un-jabbed. How come ?

    Reply
    1. Mickey Taking
      July 31, 2022

      answer – possibly you have few contacts, and avoid risk?

      Reply
      1. Mark B
        July 31, 2022

        Wrong !

        Reply
    2. Bill B.
      July 31, 2022

      Mark, you and I may soon be having to look after the vaccinated, on present trends. Or going back to work, in my case, to stand in for them.

      Reply
  11. Cuibono
    July 31, 2022

    But are we getting ANY value for money?
    Those who are there merely to carry out our political wishes imprisoned us in our homes!
    Our economy and confidence are wrecked ( beyond recall?) and we are purposely unprotected for the first time in the history of these islands.
    We are invaded without resistance and stripped of everything our ancestors fought and died for.
    And manipulated and lied to incessantly.
    A very bad show indeed!

    Reply
  12. DOM
    July 31, 2022

    An article that says a lot but doesn’t say anything at all. The public sector and the State is Labour’s power base and they will fight to the death to preserve it. If the Tories were serious about such matters they would grasp the cudgel and smash the entire edifice to pieces, but they won’t. It is easier to let it rip our freedoms and liberties to shreds, force the private to absorb the cost while they and Labour sit pretty at the table of power and privilege

    Preserving the status quo is the what the Tories, Labour and the SNP desire most. All three parties are utterly without decency and respect. Labour and the Tories were once moral and human, today they are utterly without shame or dignity

    The State is too big and that makes it dangerous to all of us. It must be reformed and reduced in size. Its functions and responsibilities must be curtailed to the minimum. It must act morally at home and adhere to the law in the way we do.

    Reply
  13. Original Richard
    July 31, 2022

    GM :

    8.7% of NHS doctors and 5.6% of NHS nurses are EU nationals. 6 million EU nationals have applied for settled status in the UK. 240,000 visas were issued last year for foreign nationals to work in the UK out of a total of one million visas.

    I think our problem is too much immigration.

    Reply
    1. Christine
      July 31, 2022

      How many of these visas are for workers and how many are for their extended families who just add to the burden? Look at incentivising British people to actually work rather than paying benefits for them to stay at home. Remove sickness benefits from obese people. Change the perverse benefit 16-hour rule to get people working full time.

      Reply
      1. No Longer Anonymous
        July 31, 2022

        Remove benefits from unemployed people who have face tattoos.

        Reply
    2. Dave Andrews
      July 31, 2022

      So you are saying the proportion of EU nationals in the NHS is less than the proportion of EU nationals in the UK population as a whole?
      Not the whole story I know. You also have to consider the proportion of medical cost spent on EU nationals.

      Reply
    3. graham1946
      July 31, 2022

      Too many people, full stop. We are probably 20 million over what this country can sustain. Immigration to replace our own ageing or non active workforce is a giant ponzi scheme that works for a while and is used instead of investing in doing things more efficiently. Short term profit is God. One day the whole edifice will come tumbling down. Those in power don’t care, they will ensure they are all well insulated and it will be the people at the bottom who suffer, as always.

      Reply
    4. Diane
      July 31, 2022

      OR : Well, the bill just went up. 460 arrivals yesterday and 247 on Friday. in 2 days, 707.
      01 JUL to 03 JUL incl. Zero
      04 JUL to 10 JUL incl. 607 / 15 boats
      11 JUL to 17 JUL incl. 1421 / 39 boats
      18 JUL to 24 JUL incl. 610 / 15 boats
      25 JUL to 30 JUL incl. 1045 / 27 boats
      Total July 2022 to date: 3683 / 96 boats
      Where are they all now ?
      ( MoD figures )

      Reply
      1. No Longer Anonymous
        July 31, 2022

        This is an invasion by (largely) young men facilitated by the Tory government.

        Reply
      2. glen cullen
        July 31, 2022

        I don’t think this government cares

        Reply
    5. Mickey Taking
      July 31, 2022

      and rather a lot of these people prefer to work and live in UK ! A clear opinion of the EU if ever there was one.

      Reply
    6. turboterrier
      July 31, 2022

      Original Richard

      Bang on the money. Far too many.

      Reply
  14. Cliff. Wokingham.
    July 31, 2022

    Sir John
    Of course value for money is very important and I suspect we would do better if we got senior negotiators from the big supermarket chains to negotiate price with the suppliers especially in the NHS.

    We also need a really brave politician to start a debate about just what we want our public services to do for us. It seems that the creation of a new regulatory body, a new public enquiry or a new inspection or overseeing body is created every other week, often as a knee jerk reaction so that it looks like government are doing something.
    Let’s hope that Liz Truss is brave enough to start such a debate.

    Reply
  15. Berkshire Alan
    July 31, 2022

    The problem we have John is not the unwillingness for Government, the Civil Service or Local Authorities to employ Private Contractors. It’s the way they are chosen, the specification put down, and the supervision (or lack of it) of work completed.
    We are having a number of roads re-surfaced here in Wokingham, not before time, but the quality of that work being completed is in many cases dire. There is not point in putting a top dressing on top of a crumbling base, there is no point in putting a top coat dressing that ends up higher than the street furniture (manholes and the like, which have not been raised to the same level) who checks this work is completed properly, who guarantees it for a period (is it even guaranteed) before they are paid for.
    Same could be said of grass cutting, again contracted out, but now done less frequently in fewer areas (Bio Diversity being the excuse) but some road junctions now have obstructed vision.
    Just two examples out of hundreds.

    Reply
    1. graham1946
      July 31, 2022

      Also who the contracts are handed to. Usually the same old, same old who have failed before and never small local firms who could do a good, timely and cost effective job. Hence the stories of people being sent from up country, South to change a light bulb at hundreds of pounds.

      Reply
    2. Julian Flood
      July 31, 2022

      It might be worth checking where the asphalt is being sourced. I suspect that the French specification stuff is being used as it is softens less in hot weather, but that softening means initiating cracks tend to heal in hot weather.
      The roads are, perhaps, being made AGW proof before the event.

      JF

      Reply
  16. Cuibono
    July 31, 2022

    Sunak is suggesting a £10 fine for anyone not turning up for an NHS appointment.
    What a cheek!
    I happen to know something of the workings of appointments etc and a no show makes not one diddly squat difference to costs etc.
    Why would it?
    You just bring in the next patient and shut up early if necessary. ( They like shutting up early).
    We used to have “sit and wait” systems anyway!

    A salon I go to has adopted new draconian “New Normal” no phone contact, no missed appts allowed without charge etc…. they keep your credit card hostage…(what to do when the internet fails..as it surely will?)
    They don’t seem to realise it cuts both ways. When I turn up on time my “operative” still chats in the back room for at least 10 minutes making my parking worries and stress levels all the worse.

    And I have never noticed a Dr keeping to appt times.

    Reply
    1. graham1946
      July 31, 2022

      Lucky if you get an appointment time at all with GP’s. If you are lucky enough for the receptionist to judge you warrant a call from the doctor the best you can expect is ‘sometime in the afternoon’ so you sit by the phone waiting and he/she rings at 7p.m. Grateful, of course for any service, but it isn’t what used to happen or what should happen. If they were paid on results we might get a better service rather than being paid by number of patients on the books.

      Reply
      1. Cuibono
        July 31, 2022

        +many
        Such a bad idea to have doctors controlled by a Marxist body.
        They should be on the High Street competing for custom.
        And totally autonomous.

        Reply
        1. anon
          July 31, 2022

          French system- you pay and reclaim a %. Incentive is clear for the Dr to see you.

          Reply
          1. glen cullen
            July 31, 2022

            I already pay up front – its called national insurance

      2. margaret
        July 31, 2022

        in every other matter on cannot stop people taking their phone everywhere.There are a few f course who only use their landline.

        Reply
  17. Richard1
    July 31, 2022

    Applying this logic a very positive first step would be for the new pm to cancel HS2 which is quite clearly a ludicrous waste of £100bn+. That would give a very positive signal. Not least we see at the moment how useless major investment in railways is if the public are then held to ransom by a small group of grossly overpaid unionised militants.

    Reply
  18. Donna
    July 31, 2022

    The original budget for HS2 was £30 billion. Then it doubled to £60 billion, and now it has effectively doubled again. We’re told it will be £105 billion but that IS going to increase, not least because of the inflation the Treasury/BoE have generated.

    So why wasn’t the idiotic, EU-promoted, white elephant – which NEVER had a real business case and certainly doesn’t have one now – cancelled when it could not be delivered for the original budget?

    Why has the NHS been allowed to double the number of managers/bureaucrats it employs over the past decade? Why have so many NHS-related Quangos been created? Why are they STILL being allowed to advertise for Diversity and Inclusion Managers at £70,000 pa like this one? Note …. this is the SENIOR Diversity and Inclusion Manager, so there will be a team of lesser individuals reporting to him/her, costing us a small fortune and contributing nothing to the core function of the NHS which is to treat patients.
    https://www.jobs.nhs.uk/xi/vacancy/917298335

    We cannot afford socialised healthcare. We can’t afford a socialist Civil Service/Public Sector. But the modern Not-a-Conservative- Party seems to have difficulty understanding the wise words of Mrs Thatcher “the trouble with socialism is that you eventually run out of other peoples’ money.”

    A quick google search pulled up 3 similar roles.

    Reply
    1. Christine
      July 31, 2022

      Well said. I saw one the other day offering 109k a year. How many doctors would that pay for?

      Reply
      1. forthurst
        July 31, 2022

        about one?

        Reply
      2. Mickey Taking
        July 31, 2022

        Junior hospital – a few, Surgery GP – barely one.

        Reply
        1. margaret
          July 31, 2022

          It takes an extra 3 years to qualify as a GP. All those who work in general practice have also been in most aspects of secondary care and seen and studied there. It is only recently that the abuse of the GP system has seen it falling to its knees. We trained many pharmacists to diagnose simple problems . We have an abundance of medically trained Nurses BUT still simple JOE wants to take his hay fever to a Dr !!!

          Reply
          1. Mickey Taking
            August 1, 2022

            simple Joe wants and reasonably expects to be able to see a GP with a real concern on health.
            Do you deny valuable input on face-to-face presentation – posture, anxiety, voice, reaction, eye contact, tics, weight loss, agility, mobility?
            If you would stick with telephone consultation only, I’d vote for a Dr Google questionning by PC.

    2. Dave Andrews
      July 31, 2022

      You would have thought recent events would have told them a state owned rail system isn’t something to be expanded. How long would HS2 be running for before it comes to a sudden halt because of union action? No trains running but costing the state for maintenance.

      Reply
    3. Julian Flood
      July 31, 2022

      Cancel Sizewell C. Look at Hinkley C if you need a reason.

      JF

      Reply
      1. Mark
        July 31, 2022

        Replace it with a sensible design option from Japan or Korea that can be built on time and on budget for half the cost or less.

        Reply
        1. Lifelogic
          August 2, 2022

          +1

          Reply
    4. anon
      July 31, 2022

      41 U.S. Code § 8303 – Contracts for public works

      Its all politics im sure, but a complete and open audit along with full open disclosure of documents would help with a better understanding.

      Reply
  19. Javelin
    July 31, 2022

    As predicted. Rishi is as dead as a dead parrot.

    It just shows how completely out of touch MPs are to think he had even a wafer thin chance of winning.

    Reply
    1. Sir Joe Soap
      July 31, 2022

      Poor them. The parties would have been great. Lots of rich guests.

      Reply
    2. formula57
      July 31, 2022

      but the present circus still has more than five long, pointless weeks to run!

      This is doing no-one any good, not the country, not the party, not its members, not the candidates.

      Reply
      1. Donna
        July 31, 2022

        It’s an excellent distraction technique though ….. for what they are really doing/planning behind the scenes.

        Reply
    3. Shirley M
      July 31, 2022

      Why? The CONS are mostly socialists these days, and Rishi is the perfect fit … for Labour and socialist CONS! Since when did many politicians care about the country, the electorate, or democracy? They virtually spit in our faces every single day by imposing laws that they KNOW would never be acceptable to the majority, ie. HS2 and net zero, but they know they can get away with it, as the opposition are exactly the same. We need a UKIP resurgence or Reform to gain a massive number of votes to shake the undemocratic politicians out of their complacency.

      Reply
    4. graham1946
      July 31, 2022

      Why did they whittle it down to 2 anyway? Why not offer say 6 or 8 and let the members choose. No wonder we end up with duffers when the system itself is duff and depends mostly on what favours are promised to MPs by the candidates. After all if only 160,000 are voting how difficult would it be to organise? I’d do it for them if they are so inept, but of course that is not the reason, personal advancement is, regardless of the detriment to the nation. The Tories have elected duds for the last 30 years and I’d be surprised if this ends up any different.

      Reply Candidates did not in the main offer jobs. The winner needs to start as PM with a good basis of MP support, otherwise a members favourite could be thrown out very quickly.

      Reply
      1. Sir Joe Soap
        July 31, 2022

        Strikes me then there’s a disparity between the Associations who choose PPCs and the Members who vote which MP becomes leader. The clear answer would be for Members to have more say in the make-up of Associations, keeping an eye on whom they actually select to end up as an MP.
        Just saying this as an independent bystander.

        Reply
        1. SM
          July 31, 2022

          SJS – the clear response to your comment from one who has ‘been there, done that’ is that you need an active and thriving Association, for which you need individuals who are prepared to give up a great deal of their time and private lives in order to run it, and who can take a great deal of flak as well as having an ever open purse.

          Reply
        2. forthurst
          July 31, 2022

          The need to dissolve the people and elect another.

          Reply
          1. glen cullen
            July 31, 2022

            Its an interesting argument – we have the right government but the wrong people

      2. Mickey Taking
        July 31, 2022

        it goes back further – the problem being who makes it to become potential MP for a constituency.

        Reply
        1. glen cullen
          July 31, 2022

          and the hurdles that the main parties, over time, have planted to hinder the recruitment of independent MPs

          Reply
    5. oldwulf
      July 31, 2022

      @Javelin
      I think most Conservative MPs believe that the majority of Conservative members do not want Mr Sunak as PM…. so that by including him in the final two, most members will support the other. By this method, the MPs have chosen the next PM.

      Reply
  20. ChrisS
    July 31, 2022

    The nonsense of NHS funding has been going on for decades : at least since Gordon Brown famously gave it billions without securing any commitment as to what the money was to be spent on. Most of it went on increased wages and as a result we ended up with the highest paid doctors in Europe.

    We had an idiotic repeat only last year with the £10bn ( or was it £15bn? ) supposedly commited for long term care but to be given to the NHS in years one and two to reduce waiting lists before being diverted to long term care.

    Anyone with a brain knows what is going to happen : as soon as the money it to be directed to its original intended purpose, the cartel of NHS managers, administrators, doctors and nurses will all be screaming that they are being forced to take a £10-£15bn cut ! Just at the time an election is in the offing, all kind of dire threats to the service will be mooted and picked up by Labour. Naturally the NHS will then be allowed to keep the money and long term care will once again be starved of cash.

    No taxpayer’s money should ever be allocated without a plan for its expenditure being submitted and approved in advance. Named civil servants should be responsible for ensuring that the plan is kept on track and, as in the private sector, they should be sacked if it isn’t.

    Reply
    1. majorfrustration
      July 31, 2022

      +1 – off topic – whilst I live in West Sussex I have just been advised that my GP is moving to Cornwall but will continue video calls. So very kind!

      Reply
      1. Mickey Taking
        July 31, 2022

        wish him luck with the comms link !

        Reply
  21. Bloke
    July 31, 2022

    With care, the healthiest Conservative Govt would spend nearer zero on the NHS.
    With care, fit and healthy citizens rarely need treatment.
    Prevention of carelessness cures waste.
    Corrections cost money.

    Reply
    1. Sir Joe Soap
      July 31, 2022

      Valid point, but when you ask your GP for a pre-emptive check, you’ll probably get told that unless you have symptoms they’re not interested. MOTs for cars are essential at 3 years old but MOTs for 63 year olds are entirely unnecessary in GP-NHS speak.

      Reply
    2. Nottingham Lad Himself
      July 31, 2022

      I agree in principle.

      However, a population which knows how to take care of itself is one which knows stuff generally, and people like that don’t often vote Tory, so don’t expect change.

      Expect their media to continue to infantilise and to cretinise, rather.

      Reply
      1. Peter2
        July 31, 2022

        Hilariously NHL thinks only Labour voters are clever.

        Reply
        1. Mickey Taking
          July 31, 2022

          sad, isn’t it!

          Reply
      2. No Longer Anonymous
        July 31, 2022

        NHL

        I must have come up in the world. Perhaps that’s why I won’t ever be voting Tory again !

        Reply
      3. Fedupsoutherner
        July 31, 2022

        NLH. Your post is not only pathetic but demeaning. My husband votes Tory. He is 75 and has had sarcoidosis in the lungs since he was 38. He has been on very high levels of damaging steroids since. He only gave up working 2 years ago. Why don’t you try and use your brain before posting?

        Reply
    3. SM
      July 31, 2022

      Bloke: and what about all those who are actually born with serious health defects because of their genes or uterine issues? Or those who, despite assiduously looking after their health, contract cancer, or multiple sclerosis, or motor neurone disease, or sarcoidosis etc etc?

      Reply
      1. Bloke
        July 31, 2022

        SM: Your question appears to assume those people would be neglected, whereas there would be far more available within the budget to raise the quality of their treatment and care to the highest level.

        Reply
        1. SM
          July 31, 2022

          You stated that with care, the Government would spend nearly zero on the NHS. I was answering that proposition.

          Reply
          1. Bloke
            August 1, 2022

            SM: I stated NEARER zero. Spending only £1m less is nearer to zero. Spending NEARLY zero as you indicate would propose spending nearly nothing.

  22. Mike Stallard
    July 31, 2022

    On Friday we popped into the vet on the way to the recycling centre. My wife was collecting a prescription for our cat. She was gone a couple of minutes, and came back clutching the medicine too. When we got our pathetic little bundle of fleas and scabs (a stray from the cats’ home) the vets were there immediately we turned up at their practice every single time (during covid too). The cost came out of our insurance.
    When my wife wanted to see her doctor…

    Reply
    1. Bloke
      July 31, 2022

      Mike:
      Maybe your wife would receive better treatment from the Vet.
      Many train to higher standards than GPs.
      The NHS tried using Pharmacists as a pressure switch but caused queues like a ‘Labour isn’t Working’ poster.

      Reply
  23. George Brooks
    July 31, 2022

    The more I hear from Mr Sunak the more I realise that he has been a significant player in delaying this country taking up the Brexit opportunities that have been sitting on the ”to-do-list” since January 2020. His bullying debating style clearly indicates that he is not a listener or a leader.

    His only claim to fame is doling out money during the pandemic during which he succumbed and fell under the ”EU spell” of the Treasury. How he tries to justify that increasing taxes for both workers and companies will generate growth defies all logic.

    As for the idea of a £10 fine for missing an NHS appointment will solve the major problems confronting the Heath Service clearly indicates that he has little or no aptitude for the top job in running this country

    Reply
    1. Mickey Taking
      July 31, 2022

      unable to organise a pi**up in a brewery springs to mind.

      Reply
  24. turboterrier
    July 31, 2022

    Sir John
    Noted with interest your last sentence of today’s post. Continuous improvement.
    The very foundation of ISO 9000. I have been pulled over many times on this site for mentioning ISO by people who tried to work with it and found the whole process a PITA.
    The reality is that with proper application, training the system works very well with everybody focused on the set targets.
    The most successful units in our military organisations are the Special Force’s. SAS, SBS, and others, all have one thing in common. Very small dedicated, highly trained teams.
    I know this will get people screaming at their screens but the NHS is tailor made for Self Directed Work Teams. There are leaner, more totally focused on their work as they are the experts in their particular field.
    Don’t start with the big roll out, pick one Trust and one department within it and trial it. As they progress the team takes over planning shift rota’s, supply chain to them JIT, organise their support departments bloods porters, auxiliaries and so on.
    I say, but I would don’t knock into the long grass till you try it. The companies I worked with where SDWT operated had a much better atmosphere. None of this brains on gate and lift them on the way home. Everybody looking for that small something that made their life easier. Working smarter not harder.
    The downside is that the need for layers of management is clearly exposed for what it is. They are the first to try and subtlety make the wheels come off as they become rapidly very exposed as the team working strengthens as does suppliers and support services.
    .

    Reply
    1. Sir Joe Soap
      July 31, 2022

      Sorry TT but the whole idea of the NHS staff filling out millions of CAPA (Corrective and Preventive Action) forms and then acting on these makes me faint. Probably a good idea for a SWAT team to go in and do a root cause analysis of failings, though. Much of it would I’m sure fall in to the “too many cooks” and “too little technology” pigeon holes. The fact that they don’t use email for interactions with patients just blows my mind.

      Reply
  25. Christine
    July 31, 2022

    Two ways of saving money 1) Fix the dire level of sick leave in the public sector. Just compare it to the self-employed to see the abuse being carried out. It used to annoy me that the malingerers would take weeks off sick and then expect to use their leave when they returned to work. 2) Put in place a staff suggestion scheme to identify savings. The best people to highlight waste are those working at the lower levels, not the highly paid manager.

    Reply
  26. rose
    July 31, 2022

    “The BBC’s snide profile of Liz Truss sounded like a Rishi Sunak promotion. Voting for Liz brings the added bonus of once again showing how out of touch with Conservative opinion the BBC are.”

    And typical of the BBC to think it ridiculous to promote British cheese over foreign. Our cheeses are excellent and numerous. There is no need to buy foreign cheese. Ditto for British meat and poultry which are superior to any from abroad. This brings to mind Mrs T’s crusade against Perrier water. That was ridiculed too but we don’t see Perrier on every table now.

    Actually, Timandra Harkness is a whole lot more intelligent and less hostile than the usual Profile presenter. After all, she managed to side step the producers to leave us with a picture of a woman who was brought up with maths and music, a brain training combination of the first order; a woman who thinks for herself and isn’t afraid to go out on a limb; a woman who was talking about the big questions all along. Not very many of those in the House of Commons these days, though there are some.

    Reply
  27. Jim Whitehead
    July 31, 2022

    NHS Forest of Quangos, and not just a thicket to hack through.
    GPs in short supply, unhappy and resentful of that overbearing quango, the CQC.
    If that body performed a fraction of the audits on its own workings and effects that it insists upon for the doctors and dentists then it would disband itself.
    Formerly a morale sapping threatening officious body, and a major cause of early retirement from the vocation of medicine (early retirement from a vocation? What does that imply?), the CQC now plan to foist over 30 ‘statements’ that a GP must avow, statements which Pol Pot might have admired.
    Looks like our GPs must ‘lie to comply’, much as was demanded by the state behind the Iron Curtain.

    Reply
  28. Julian Flood
    July 31, 2022

    Re NHS problems – at last, I was led astray by comments above.

    NHS funding is inflexible – how very socialist – and works on a one size fits all model. I saw the problems with this in Haverhill when I was a councillor. The local medical services were obviously underfunded and I found a Cambridge academic who explained what was happening.

    When a fairly cohesive population moves en masse, as happened to the new towns in the ’60s, they bring with them their lifestyle choices. Good or bad those choices last for THREE generations before the new population’ s health profile merges into the background. If the incoming population has a less than optimum diet, less exercise, more smoking etc etc they will age faster and the NHS model that expects the uptick of age-related disease at seventy, say, will underfund a population where that happens at sixty.

    Health funding that does not take this into account will cause problems for SIXTY years.

    JF

    Reply
  29. glen cullen
    July 31, 2022

    By any measure, how is spending £150 billion on HS2 sensible government

    Reply
  30. Bryan Harris
    July 31, 2022

    This ‘Back to Basics’ methodology series is clearly something potential UK PMs should understand even before they arrive at Westminster – but will the new PM take any notice?

    Anyone who despaired through the Blair years, as he ruined the country, pushing us inexorably left and bringing failed socialist dogma into our lives, will understand this far more easily than the Woke generation, who now see socialism as ‘normal’.

    Socialist politics are about ignoring problems by throwing money in their general direction — This makes it appear that something is being done, but the extent that this is used to give a government good PR or persuade the public that HMG is pro-active, just demonstrates how far to the left we have fallen as a nation – how successful Blair was!

    Reply
  31. SecretPeople
    July 31, 2022

    I’m glad you said this:
    “Patients will judge the NHS by how easy it is to get access to diagnosis and care, and by how successful the care and treatment is. They will not judge it by how much it costs.”

    It so annoys me when the PM or ministers outbid each other by each declaring an eyewatering amount of our money they will lob into the bottomless bucket of ‘our NHS’.

    What we want to hear is the STRATEGY – HOW will they reform and improve the NHS – ultimately, HOW will they improve patient care and fairness of access, increase efficiency and reduce waiting times. What is the plan?

    Reply
  32. Mickey Taking
    July 31, 2022

    The ‘Nanny State is alive and well’
    Unhealthy food promotions will be banned in supermarkets and convenience stores across the UK from October 2022, with ‘buy one get one free’ or ‘3 for 2’ offers on biscuits, crisps and sugary cereals soon to be a thing of the past. The move forms key part of the government’s strategy to tackle obesity and will require supermarkets to phase out multibuy promotions, but as supermarkets begin to prepare for the upcoming legislation, the wider ramifications of the government’s diet-based policy are becoming clear.
    The future of retail marketing and promotions can already be seen in select Tesco and Sainsbury’s stores. Customers are able to catch their first glimpse of what a healthier shopping experience will look like, with HFSS promotions removed from key area including checkouts, store entrances, aisle ends and their online equivalents.
    However, the ambiguity of the HFSS legislation, the lack of evidence supporting its effectivity and the omission of underlying factors of obesity have also seen doubt among organisations and consumers. So how will HFSS shape the way we shop?
    In the last week Sainsburys and Waitrose in Wokingham have been altering their layouts to meet the above requirements.

    Reply
  33. BOF
    July 31, 2022

    Government is now infested with diversity, equality and inclusion with hours of staff time taken up in meetings and training and dedicated overpaid departments for the brainwashing and politicisation of staff.

    Remove ALL of this from public bodies. This is about lifestyle choice and government should only be concerned with equality before the law and equality of opportunity. This would be the conservative way resulting in massive savings to the public purse.

    Reply
    1. glen cullen
      July 31, 2022

      Your first para costs the UK employer and extra 5-10% against its international competition….they think we’re fools – and they’re correct

      Reply
  34. MFD
    July 31, 2022

    Roy you clearly do not understand the tendering process the civil servant has to follow.
    My experience from estate management was-
    1 I set out the needed outcome from the tender.
    2 This is fleshed out with my agreement by private company ( estate works consultant) and passed to another private company( works services management) to tender with approved contractors. Tenders opened in my presence and went to the lowest tender ( despite me sometimes feeling it was the wrong firm for the job.

    Defence Estates ( an other organisation) carried out regular audits.
    The civil servant clearly has no room to manoeuvre as you can see.

    Reply
  35. Donna
    July 31, 2022

    After 12 years of supposed Conservative Government, from today’s Sunday Telegraph:

    “The Home Office has been accused of failing to take fraud seriously as figures showed just 31 officials were dedicated to tackling the crime – less than a quarter of the number of its staff working on PR.

    The number of officials working on the crime is dwarfed by the Home Office’s press office, with the department employing 131 communications staff in total.

    Fraud cases have soared in recent years, with the number of victims rising from 3.1 million in 2019 to 4.1 million victims in 2021, according to the Office for National Statistics.

    https://www.telegraph.co.uk/politics/2022/07/30/home-office-has-four-times-many-people-pr-has-tackling-fraud/

    I presume Priti Useless will be addressing this disgraceful state of affairs on Monday. And the PR redundancies or enforced redeployments to the Fraud Team will start on Tuesday?

    Or will it be another case of “move along, nothing to see here” business as usual for the Not Fit For Purpose Home Office?

    Reply
  36. outsider
    July 31, 2022

    Dear Sir John, Mr Sunak highlights the “waste” of missed NHS appointments. This is familiar to me as I recently had to phone the local surgery on several occasions on behalf of an elderly relative. Each time a recording about this problem was played while one waited for up to 23 minutes to get through to a receptionist. I imagine that many appointments are missed because of some unexpected family or personal emergency, when the patient could not hold on for 15 minutes for a receptionist. If anyone really cared, that problem would easily be solved by having a voice-mail facility.

    Reply
    1. SM
      July 31, 2022

      +100

      Reply
  37. Original Richard
    July 31, 2022

    There will never be any improvement in the service or the value for money spending by the Civil service or by quangos or by any of the public sector until there are seen to be sackings for poor service and profligate, careless and unnecessary spending.

    Reply
  38. ukretired123
    July 31, 2022

    Based on my professional experience in the private sector there is massive waste and fraud in the Public too but we never hear about it as it’s controlled by the unaccountable secretive Civil Service unions default position.
    Before the digital age you could still calculate the taxpayers inputs and outputs of the “Black Box” budgets. We pay a kings ransom for mediocrity and non delivery of basic services. No one gets fired but moved sideways or worse promoted or retired.
    The Kemi Badenoch DT article on Tavistock clinic gives you a glimpse of how the CS give scrutiny the elbow when it comes to independent oversight.

    Reply
  39. agricola
    July 31, 2022

    UK government all too frequently offers a take it or leave it service. Where there are private options those using them should be able to offset the cost against their tax liability. Anyone using private alternatives is assisting government by reducing their responsibility to the individual.

    Additionally there is a ticking time bomb of taxes, not only unaltered with the passage of but totally anti Conservative in that they exist at all. Most penalise already taxed income which by any measure is immoral or state theft if you prefer. To those who ask, where is government to get the money from, the answer is to cancel the need for that money, stop spending.

    Reply
  40. Bloke
    July 31, 2022

    A jiffy computer summary of yesterday’s 149 comments about ‘Personal Journeys begin at School’ read as follows:

    “The greatest influence on a school is the headmaster/mistress, get that wrong and the school fails. The CONs have had 12 years to improve education standards in our State Schools. The golden age for state schools was when we had plenty of grammar schools, offering a good education free of charge. I agree grammar schools gave children like Andrew Neil, Michael Portillo, and Dianne Abbott a leg-up to compete with public-school children. KISS Keep it simple is basic thinking for children in primary school.”

    Computer says Yes to:
    Berkshire Alan, Donna, Wokinghamite, Ralph Corderoy & ukretired123.

    Reply
  41. forthurst
    July 31, 2022

    The qualifications of medical staff trained in this country is rigorously controlled yet there is no control whatsoever of the civil servants who run the NHS at all levels. Doctors should not need managing by people who have no useful skills for whom the NHS is a gravy train. The medical director of a hospital should be appointed by his fellow medics who should then appoint an administrator to oversee the
    management of the hospital. The NHS likewise should be run by qualified physicians as in Germany.
    There is really very little that Arts graduates can usefully do in running the country as they have none of the backgrounds essential for giving informed advice to governments, hence defence procurement disasters etc.

    Reply
  42. Pauline Baxter
    July 31, 2022

    Careful Sir John, talking common sense is a bit radical isn’t it? (L.O.L.)
    One point about the spending on the N.H.S. – yes of course it is important what the money will be spent on but surely that is the Heath Minister’s job, before the request gets to the Treasury.

    Reply
  43. Margaretbj.
    July 31, 2022

    One can spend.money, implement policies but what matters ultimately is staff effeciency, effectiveness and quality.

    Reply
  44. mancunius
    July 31, 2022

    “The NHS does need a slimming of senior management” – No no no! The NHS needs to be *abolished and replaced* by a contributory, tiered, income-linked insurance system: the insurance companies will be aware that their contributors’ monthly payments are a) capped by regulation and by an unwillingness of their customers to pay more than they have to, so as businesses they will be keen to ensure money is not wasted.
    Private insurances (such as BUPA) can continue to exist, but without the special interest group discounts and over-provision of unaffordable services that make such systems unusable by the net contributor.

    Reply
  45. Geoffrey Berg
    July 31, 2022

    This is a very good blog so far as it goes which is not far enough. There should not only be better value for money spent but also less spending (in supermarket shopping people don’t just want value for money, they also have a maximum budget) if substantial tax cuts are to be maintained. I hope for instance John Redwood impresses the new Leader of the need to substantially reduce the very swollen by Covid NHS budget (which he was rightly blogging about several months ago).
    Yet more than that we have a fuel crisis causing cost of living inflation and industrial unrest crises. The government needs to grasp the nettle on this. This crisis arises not because of increased costs in extracting oil and gas or in producing electricity but because of scarcity causing rich global customers to outbid poor global customers. (Incidentally I don’t see why other costs within fuel bills such as pipeline, repair, billing, marketing etc., which are considerable are allowed to go up.) That is the world market but in the British market, North Sea gas and oil and British electricity production the government should take emergency measures to force producers to supply the British market first (as India has done with Indian suppliers of vaccines and food) and at cost with small profit prices, not at global scarcity prices. If the government doesn’t do this quickly our social security system will become unmanageable and the British economy will crash, probably at least as much as in The Great Depression since most people won’t have adequate money left for non-essential goods resulting in mass bankruptcies and mass unemployment in those sectors.

    Reply
  46. glen cullen
    July 31, 2022

    £20 million…the cost of illegal immigration hotels, or the shortfall of some council budgets or circa 500 police or a faction of what octopus energy is asking in a loan (£1bn)…..spend wisely

    Reply
  47. Peter Gardner
    August 1, 2022

    The problem with John Redwood’s prognosis is that it is driven by the government. The Government does not know how best how to manage medical services. it does not know how toslim down management. I have emigrated to Australia. The most obvious difference in the provision of healthcare is the freedom of choice given to Australians and the resulting better services in terms of outcomes. I believe that derives from the fact that patient choice directly determines the flow of funds to providers whether the sources of funds are taxpayers o, individuas or private insurance funds. For example, the government (taxpayer) pays GPs per consultation, not per patient on their register. GPs may charge more thah the Government scheduled fee if they wish. The patient can choose any GP they wish. There is no restriction by postcode or other regulation.
    When you need specialist services you can choose the provider, acting, if senesible, on the advice of your GP and the experience of friends and colleagues. you don’t need to be an exert in cancer treatments or whatever to be abkle to make a choice. Tony Blair eliminated “patient choice” using the argument that patients are not competent. But they don’t need to be. The word spreads rapidly if a hospital or doctor performs badly and patients go elsewhere and take the funbding with them.
    There is also a better integration of public and private sectors in Australia. Even if I go to a private hopsital, gthat hospital is still paid the government scheduled fee for the procedure from taxpayers. That is the marginal cost. In addition I pay an amount and my insurance also pays. But I could also choose to have the same procedure in a public hospital and if the waiting times are not an issue (usually longer in public hospitals) I would choose that. In consultation with my GP or specialist my priority would be to get the best provider for what the treatment I needed. And if I go to a public hospital, it isn’t free I get a bill so I am aware of the costs but I can send the bill either to the government or to my insurer. In the NHS it’s free and there is no bill so there is no awareness of costs.
    The main point is that it is my choice that directly determines which providers are paid, whatever the sources of the funds, and I am aware f the costs of the various treatments available to me. that is informed patient choice that underlies sensible market competition in healthcare.

    Reply
    1. Peter Gardner
      August 1, 2022

      Apologies for my typos!

      Reply
    2. Peter Gardner
      August 1, 2022

      Quick correction. In a private hospital the government scheduled fee is not paid wholly by the taxpayer, as I wrote above, but is split between the taxpayer and the insurer.

      Reply
  48. Lindsay McDougall
    August 2, 2022

    The plain fact is that the public sector does not look after the financial interest of taxpayers. So why don’t we reach the obvious conclusion, namely to make the public sector as small as possible?

    Reply
  49. Lynn Atkinson
    August 4, 2022

    It is the amount of money that you (print and) spend! Those of us whose businesses were closed down for 2 years and who had no cessation in business rates (the landlords) have already paid for Boris. It is now time for the Corporations who traded without competition from the private sector for 2 years, raises cash free of interest rates on the Stock markets and pays very low levels of tax, and the State sector which enjoyed pay increases throughout the 2 lost years, to pay their bit for Boris.
    The state sector in particular should be cut to the bone! Yes – that is how expensive Boris was.
    Unless we get a monetarist genius in Nr 11 who can lead the Bank of England by the nose, we are on the brink of destruction which will surpass all previous disasters.

    Reply

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