There is no credible evidence that the Roman Emperor Nero actually ‘fiddled while Rome burned’. Historical pedants say that, in any case, he would not have had a fiddle but rather a guitar-like instrument called a cithara. Whatever Nero did or did not do, the metaphor of fiddling while Rome burns has entered and endured in the lexicon. What is worse, it has been taken up as a full-time occupation by those—from the government down to senior management—responsible for the NHS. And a prime example of this fiddling is Secretary of State for ‘Health’ and Social Care Sajid Javid MP and his expressed desire to make COVID-19 vaccinations compulsory for all NHS staff. What does he think this will achieve? Is he trying to bolster people’s confidence in the NHS (too late), make it people’s preferred provider (also too late, it is effectively a Stalinist state monopoly) or is he just another convert to the new religion of COVID-19 vaccination? There is also the possibility that this is one in the eye to the thousands of care home staff who, refusing to be forced into compulsory vaccination in the care home sector, have fled to the NHS hoping to find a job. Well, now they have nowhere to run.
The UK NHS is a disaster and, while often lauded as the best in the world and the ‘jewel in the crown’ of the UK welfare state, it is not the best. It is not even in the top ten and only just makes it into the top twenty. It is ought to be recognised for what it is: a national embarrassment. In fact it is a £129 million a year embarrassment. And now that we have ‘saved the NHS’—as if we were given any choice—how did the NHS repay us? It killed people. It increased cancer deaths and deaths from other diseases that went undiagnosed during the pandemic as well as the thousands of older people it banished to nursing homes to await their fate. This has passed with neither apology nor explanation from the NHS or the government while all resources were diverted to dealing with COVID-19. Yet the NHS lapped up the adulation during the ‘clap for carers’ cult. Nurses had the audacity to demand a pay rise despite the fact that none of them lost their jobs, while others did, during the pandemic and hiding the fact that many—if not the majority—never encountered a COVID-19 patient. Some sat around for months in the Nightingale hospitals that were never used.
And now, having ‘saved the NHS’ (I reiterate), apparently it is short of £10 billion which is needed to return to providing the woeful service it was providing until March 2020. And guess who must pay for this? Us, through a hike in National Insurance contributions. Even if the money were justified, what is it likely to be spent on? More nurses, more doctors, more screening or more operations? At least part of it will be spent alleviating the perceived emergency in inclusion and diversity. You don’t need to trust The Daily Telegraph on this one, check jobs.nhs.uk website. Admittedly, that is a slightly facetious take on planned NHS expenditure, but it does exemplify the propensity of the NHS to waste our hard earned taxes on trivia and is indicative of the mindset in this ridiculously overstaffed and overpaid organisation.
The NHS has an organisational structure that—apart from being hard to find—is impossible to fathom. The NHS is not a single organisation, it is a series of quangos and fiefdoms, a great many of which have nothing whatsoever to do with direct patient care. In fact, the inclusion and diversity industry that exists within the NHS demonstrates that some aspects are not even indirectly related to patient care. Trying to find and list the number of organisations that purport to be ‘the NHS’ is to lose the will to live. There is an organisation called the NHS, but there is also the NHS Confederation, NHS England, the NHS Executive Group, Public Health England, and NHS Procurement. I have hardly scratched the surface. The other three ‘countries’ of the UK have their own NHS leviathans. Here in England, we have NHS hospital trusts (some with the status of university trusts and some as foundation trusts) mental health trusts, ambulance service trusts, and hundreds of clinical commissioning groups. I will, undoubtedly, have missed a few organisations. But the point is that these organisations each has a series of chiefs and a retinue of Indians all paid out of the public purse and each will have at least one non-executive director well renumerated for doing little else than lending their name to a list of people on the minutes of one of the many mindless meetings on which the NHS appears to thrive.
It is well recognised that the NHS does not work. If not, then why since the mid-1970s have there been so many reorganisations? Barely a parliament goes by without one or the threat of one. This is surely a sign that something is wrong, but so wedded are we to the idea of the NHS and health care that purports to be ‘free at the point of delivery’ that leaders from both main parties continually fail to tell the Emperor that his clothes are threadbare, if non-existent. The fact that money does not change hands at the point of delivery does not mean it is free. And if the NHS has its way, then it will become increasingly expensive.
Reorganisation is not the answer. As one local surgeon once explained to me, the NHS is like a sinking ship on which, instead of plugging the leak, we keep building cabins. It is beyond my capability to suggest exactly how the NHS could be reformed. I am not as naïve as think it could be abolished and there is probably no need to resort to that. But I can suggest a starting point. Each NHS employee, from the cleaners and cooks to the NHS Chief Executive should be interviewed and asked to explain in a single sentence how their job has a direct and beneficial influence on patient care. Any ‘ifs’ or ‘buts’ or the slightest hesitation and they are handed their P45 and an application form to become an HGV driver. That ought to strip out a few tiers of management and see off the equality and diversity directors. That’s my prescription…repeat as necessary.
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