The Telegraph reports a BMA call for more consultants in the NHS.

This is supported by research finding that consultants, the most senior and experienced doctors, produce better results in a number of areas.  No one is going to dispute that, it seems pretty obvious that if your doctors are more experienced they will offer a better standard of care.

However, the reason why we don’t have as many consultants as in other countries isn’t that we’ve been stingy with the health service.  Funding has gone up rapidly and we now spend just about exactly at the OECD average.  It is that increases in funding have been soaked up by a healthcare system unable to turn that new money into results.

What the BMA don’t mention in its discussion of the number of doctors is how expensive they have become.  While we don’t have a lot of consultants, our doctors are among the best paid in the developing world.  This can be seen in the OECD’s Health at a Glance 2007 statistics on physicians remuneration (XLS).  Our GPs are the third best paid of the 23 OECD countries relative to GDP per capita, our specialists are also paid well above the average (the eighth best paid).  Pay has been rising rapidly despite falling hours due to the Working Time Directive.  Unfortunately, it seems unlikely that the BMA will acknowledge that the problem isn’t a lack of resources but the direction of resources into things like big pay increases instead of areas more conducive to improving results and the patient experience.  The money to pay for all this is taken from hard pressed taxpayers who have been forced to foot some extravagant bills in recent years.  If our doctors are to enjoy such high earnings there will probably have to be fewer of them than we might like.

This is just one of the pressures pushing up costs in the NHS, we identified several drivers of NHS inefficiency in our report Wasting Lives: A statistical analysis of NHS performance in a European context since 1981 (PDF).  The Kings’ Fund reported that 73 per cent of additional spending in the NHS in 2004-05 was consumed by cost pressures; the number of managers and senior managers grew twice as quickly between 1999 and 2004 as the number of clinical staff; endless reforms and then reversals have been massively disruptive.  Instead of offering the rather obvious bromide that things might be better if we had more expensive consultants, it would be nice if the BMA would reflect on the fact that the NHS has seen little result from a big increase in spending and direct their campaigning attention towards seeking serious reforms in the way the health service operates.  In Wasting Lives we set out what the priorities should be: ending political management, ensuring proper competition and delivering real decentralisation.

After all, this story provides more examples of how politicians fail to effectively manage the health service.  They weren’t able to properly control pay and other costs when resources were plentiful.  Spending shot up at a clearly unsustainable rate and, instead of delivering similarly radical changes in results, built up momentum in various cost pressures.  Now that money is relatively tight pay deals are going to have to be more restrained and staff are upset but still highly paid due to past profligacy – we’ve got the worst of both worlds.  In order to avoid a financial crunch in organisations that had got too used to plenty NHS Trusts took radical, destructive steps like cutting back on nursing (contributing to hospital infection epidemics) or freezing consultant recruitment.  This is a fiasco that patients and staff pay for every day and is the direct result of politicians, with experience in neither healthcare nor managing large organisations, believing that they could easily translate resources into results and dictate improvement via targets from the centre.

Stories today, and over the weekend, illustrate how the problems with public sector management undermine attempts to keep hospitals clean and hygienic and control scandalous levels of hospital infection.  There is no reason to trust politicians to deliver high quality healthcare.  Control needs to be returned to professionals and patients with decentralisation, competition and an end to political management as set out in our report Wasting Lives: A statistical analysis of NHS performance in a European context since 1981 (PDF).

Lack of accountability

In the Byzantine public sector it is rare enough that there is a single organisation and person clearly responsible when things go badly wrong.  When that does happen there is often, briefly, accountability to the public.  However, it doesn’t last as the issue doesn’t stay in the public eye for very long.  After the breathtaking loss of personal information on millions child benefit claimants the head of HMRC, Paul Gray, did resign.  This was hailed as a triumph of accountability.  However, he kept getting paid his £200,000 salary and was quickly engaged in a new project advising on, somewhat ironically, "transformational government".

Now it emerges that despite a payoff of half her annual salary Rose Gibb, the NHS Chief Executive who oversaw Britain’s worst superbug outbreak with over 90 deaths, is launching a legal claim for even more.  Gibb was responsible for shockingly poor management and hygiene conditions at the Trust.  Her own leadership style was cited as a significant factor in the Healthcare Commission report (PDF) on the crisis.  She should consider herself lucky that she received any payment; a company director responsible for such dire safety standards might face a substantial jail term under corporate manslaughter laws.

Inexperienced leadership

Gordon Brown and Alan Johnson haven’t spent their careers working in healthcare.  They’ve spent them as politicians.  However, healthcare professionals have to, in the end, respond to the politicians’ priorities.  They’re the ones holding the purse strings.

Deep cleaning is a classic example.  From the day it was announced experts, including the Lancet medical journal and the companies hired to actually carry out the deep cleans have suggested that could make a minor contribution at best and could prove an expensive gimmick; a poor substitute for good hygiene delivered by effective management.

Sure enough, the critics of the scheme appear to have been proved right.  The Mail on Sunday has reported that one hospital has suffered a C. difficile outbreak just days after it was deep cleaned.

"The figures show that over the past decade the number of persistent young offenders (PYOs) in England and Wales has jumped by two-thirds from 9,868 in 1997 to 16,512 in 2007.

A persistent young offender is defined as "a young person aged 10 to 17 years old who has been sentenced by any criminal court in the UK on three or more occasions".

The human cost of this rise in youth crime, reported by the Telegraph, must be hard to overestimate.  This highlights how overall crime figures, distorted by a fall in the number of thefts from a vehicle, miss the true social and economic costs of crime.  More young people getting trapped into a life of crime.  More of those crimes, like violence against the person, which do the most to blight the lives of ordinary people.

The Telegraph reports a big increase in the number of complaints about the NHS:

"The Healthcare Commission, the independent watchdog, investigated more than 10,000 cases last year. Complaints included cases of patients left in soiled bedding and allegations about rude nurses.

The commission upheld 20 per cent of complaints, more than twice as many as the previous year. Almost a third of complaints about hospitals involved lapses in basic nursing care.

Patients reported that they did not receive regular baths or showers and, in some cases, were left for hours in soiled bedding or clothes."

So long as we’re just complaining to an organisation which is, in the end, accountable to politicians we won’t get anywhere.  Only if patients are given the power to take their business elsewhere when ill-treated by hospital staff will there be the right incentive for improvement.

There is room for debate on whether reducing inequality is a proper goal for government.  Too often attempts to tackle inequality substitute petty attacks on ‘the rich’ (usually the middle classes are the ones actually affected) for meaningful attempts to help the poor.  However, as reducing inequality has been a central objective for the Government for over a decade it is important to look at measures of equality just to see if they are succeeding in their own terms.

They aren’t:

"Karen Dunnell, head of the Office for National Statistics, said the income gap between high- and low-earners was not affected by the measures introduced while Gordon Brown was chancellor to raise the living standards of the poor."

It isn’t just that we might differ with the Government on questions of priorities.  Even on the issues they have set up as central concerns for their government our present Ministers have failed dismally.  Clearly,  we need to look at the ability of our present system of government to get things done.

Despite public services, managed by politicians, failing in so many areas politicians are still trying to further their control over the rest of us.  The rate at which new regulations are imposed is even increasing – hurting Britain’s competitiveness and creating endless new frustrations:

"Red Tape Day looms this week with business owners facing a raft of new employment regulations and tax changes.

In total 82 new rules, including corporate manslaughter legislation and rules to protect staff from sexual harassment by customers that impact on businesses will be implemented on April 6. This is a 12pc increase on last year, according to Sweet & Maxwell, the legal information provider.

The day is one of two chosen by the Government as so-called common commencement days to make it easier for employers to track new regulations. The other date is October 1.

Sweet & Maxwell said that the ensuing week will see the introduction of even more rules for businesses to get to grips with, giving a total of 128 compared to 81 introduced around the April Red Tape Day last year."