NHS, Where has all the money gone?

In some respects, one can argue that the Tories are now reaping what they sowed four decades ago.

Very few people (in my experience and occasional straw-polling of students and fellow academics) have ever heard of the philosophy of 'New Public Management'. And of course, since it's now 40 years old it's hardly new anymore. However, most of the problems across the public sector and most strikingly in health, derive from this Thatcherite philosophy. You know the one... 'the most effective way to run an organisation is as a business'.

Hospitals, schools, Fire & Rescue Services, the Police...even Defence, have been subordinated to commercial and business style managerialism for four decades and the reality is that you can't run public services as if they were private businesses, yet we persist largely because this NPM philosophy was slowly and subtly introduced without great fanfare and has consolidated itself to the point that no-one notices (or as above, have ever hear of it as a distinct and coherent philosophy).

Thus in answer to your question, Zany, the money is diverted from coal-face patient care into self-serving managerial roles earning eye-watering salaries, swoopy, award-winning new hospital buildings that make delivering care more difficult, but which project an image of modernity and style - like the corporate HQ of a multinational business - and a 'spend to save' attitude in terms of adding layers of expensive bureaucracy in order to 'give the impression' of saving taxpayers money. 

In particular, however, the effect of NPM is to breed short-termism, not only in strategic management, but also right at the coal-face. If you give a clinician a budget, and then make their annual appraisal focus on staying within that budget, they make short-term clinical decisions that kick the cost can down the road. Since I started nursing in 1989 I have seen this transition in action. These days - and the pernicious and subliminal nature of NPM has intentionally fed this - doctors, nurses and other clinicians will look to do as little as possible for a patient, because unconsciously they're more worried about the taxpayer than the patient in front of them (despite the two usually being one and the same). Instead of throwing everything, including the kitchen sink, at a patient to cure them, they fiddle about and fuck around, doing the least they can get away with, so that they can stay within budget for this financial year, forgetting that their penny-pinching in this FY is going to A: prolong the suffering of the patient and B: add costs to the next FY, and perhaps one or two more FY after that. In short, instead of nipping things in the bud, they prolong the agony - both physical/mental and financial.

Plenty of academics have argued that if we re-focused on preventative healthcare and health promotion/education, we could make a big dent in the health budget. But because the business mindset that comes with NPM is so short-sighted, Trusts and CCGs are forced to be solely reactive, rather than effectively proactive. It's a lot easier to sell a bean-counter the idea of spending on problems as they happen than on spending to prevent them happening in the first place. 

My wife experienced this first hand as a neuro radiographer for 30 years. Every couple of years they would be gathered together asked for opinions on how the department could improve performance and roundly ignored. 

What made her leave was the focus on ticking the boxes to say the patient was seen within the stated penalty period, though often no progress was made. 
Its very disheartening to let people down like this on a daily basis. 
Though its wasn't as bad when she switched to Neurology as most of these patients were extremely critical, but another management change dissolved the specialist team back into the main department.
Sigh. 

Now she has just seen it from the opposite end (With the insider experience to know its happening. 
4 years ago she tore the  pectoralis tendon off her sternum. For 4 years she was given tiny clean out ops or steroid injections always just within the specified time limits for treatment. Last time she was offered another steroid injection she refused it. 
I asked does that mean they have to do the op properly she said no, the system will record they offered treatment and I refused it. Even though both she and the surgeon (Who she knows) agreed it would be pointless. 

So yes I agree with your synopsis. 
Though I often wonder with the Tories whether its a deliberate attempt to make public health seem expensive and clumsy for the obvious reasons. 

Q: We have heard hints of change from Kier Starmer do you think that's plausible. 

The Tories brought in this idiocy of making individual departments focus on their efficiency and not have anyone focus on delivering a solution for the patient across multiple departments.

To get the urgent cancer treatment I needed a few years ago I had to become the solution manager connecting up and chivvying up separate departments and shaming those who failed. Even with that the NHS delivered late compared to its promises and I hate to think about how someone getting a similar diagnosis now would fare.

Does anyone think the majority of Tory MPS or indeed any of their ministers relies on the NHS? I don't.

Yes, it was that Labour seemed to be talking to doctors again rather that just telling us what was needed. I live in false hope 

You seem to be talking in Riddles. I'm talking about the people who control the actions of the Tory party.

i'm surprised you had less to say about their manifesto here.

Constitutional reform
Desecration of tradition
Importing endless migrants
Legalistic persecution of native Britons

The Tories tick a lot of boxes for you. It might be worth thinking about.

You have described what has been going wrong very well and from an insider perspective. I have long believed that the problem is as you have described it, but you have summed it up far better than my own words ever could have. 

It ought to be a no brainer that spending whatever it takes to most effectively resolve a medical problem now will save money in the longer term, but focussing upon cheaper sticking plasters to save money in the short term and kicking the can down the road inevitably costs much more in the end. It almost certainly costs lives in some cases. And contributes to the growing number of people off work for medical reasons of one kind or another.