Clear and obvious truths about the NHS

This starts well:

At last a glimmer of light on the NHS horizon. Labour’s shadow health secretary, Wes Streeting, clearly smarting from his brush with cancer two years ago, has realised that the problem with the NHS is not just cash but structure. Above all, it lies in the costs and delays of an archaic network of occupational demarcations seizing up surgeries and hospitals alike.

The sheer lumbering vastness of the NHS has sent it slithering down the league table of world health services.

One way of thinking about this is that we’ve simply not got the management techniques to run an organisation of 1.2 million people. This is beyond humanity’s ken, d’ye see? The other illustration being that we don’t know how to run, directly and in detail, 11 or 12% of an entire economy. GOSPLAN didn’t work and the same management style also doesn’t work on significant fractions of an economy.

So, yes. Even if we then go on to say that health care in the UK does need more money - not something we’re willing to agree to other than for the sake of this specific following argument - it is still true that we need to sort out that structure within which we’re to do that spending.

The only management technique we’ve got at such scales is the use of markets. No, this doesn’t mean the US health care system, that of France or Germany uses markets. Multiple suppliers, their activities coordinated by the use of prices. It’s entirely possible to retain, if this is desired, that principle of single payer - as some European health care systems do.

We’re also not insisting upon capitalism, only upon the use of markets. It’s not ownership that is the point here, it’s the system of deciding who does what to whom, when. That system that markets can and do coordinate and planning - clearly and obviously - does not.

Having laid out the problem then of course everything goes wrong:

Labour, says Streeting, would turn GP surgeries into health centres. Doctors would no longer rule the roost: GP “partners” now earn an average of £109,000 a year. Doctors would revert to being salaried NHS employees, working alongside nurses, therapists and technicians, and handling the vast majority of health cases that don’t require a hospital visit.

No, that is to increase the centralisation, to subject yet more of the system to that detailed and ineffective control. Employees are, obviously, more directed in their activities than independent contractors after all.

If we are to say that changing the NHS would make it better - which we insist is a glaringly obvious, umm, observation - then it would be a good idea to look around at other systems and pick up bits of those other systems which we think work better. Say, the Singapore system, which seems to produce better results at half the cost. Or, the Swedish, or Danish (both much more local) or the French (more competition among providers) or the German (more competition among financiers) or, or, or…..rather than coming up with home grown changes which will only make the diagnosed problem worse. Like sucking even more of the system into that centralised control as suggested here.

One final truth about the current system. It is often claimed that the NHS system - that lack of markets, that central direction - is more efficient than other management methods. It is also often claimed, usually by the same people, that the NHS is underfunded because it doesn’t receive the same resources as those other, more inefficient systems. Both cannot be true. If the NHS is more efficient in structure then it should cost fewer resources for the same output - because that’s what more efficient means. Therefore anyone arguing that the NHS should receive the same resources as other systems is, by definition, arguing that the NHS is not more efficient.

Therefore we should make it more efficient, shouldn’t we? Markets it is then.