Lions Led by Donkeys?

The title of this posting was first applied to the allied soldiers rotting in the trenches in the first world war. It is a phrase that often haunts me when I collide with NHS management. I am weary of sitting with groups of managers and those GPs that get involved in management and hearing them defend the NHS as something that is far too good and noble to be tainted by the whiff of commercialism or those with a "profit motive". From where I sit, the NHS isn't very good at all. It is grossly inefficient; appallingly profligate with taxpayers money; and it delivers a large amount of mediocre care in buildings that would be the subject of criminal prosecutions if they were not the responsibility of the government.

The average NHS manager has no real grasp of financial management and no grasp whatsover on the real meaning of cost. Few managers have any formal training for whatever role they assume. My son is a project manager for an international telecomms giant. His team are experienced in project management and work effectively in every corner of the globe. I dare not recount to him how my PCT is (not) managing our NHS broadband connection whilst he's eating as he could easily choke whilst laughing. Few if any of our local managers have the faintest idea how much the services they manage actually cost and there is no accurate means of measuring forecast vs actual costs. Our prescribing budget is usually set six months into the year. Mind you, there is no point having a real management information system. The management couldn't work it nor usefully interpet it anyway.

Before you all start shouting at me, let me acknowledge the tens of thousands of workers in the NHS trying their best to deliver good care to sick people. There are many small islands of excellence. I am grateful to live in a country where I will get treated if I am ill even if I can't remember the PIN on my credit card. However, these facts have nothing to do with the way the NHS is run. In fact, shouldn't it be these people shouting the loudest?

Blair and Brown inherited an NHS that was leaking vast amounts of money (billions!) through waste and inefficiency. It was grinding to a standstill with waiting times, poor access and declining hygiene. This dismal catalogue was the evidence of NHS management outcomes. Blair's prescription was to throw money at the problem. Even our village idiot could tell you that whilst you might eventually fill a leaky bucket if you poured enough water in, the moment you stopped pouring it, you will be back at square one.

And so we are!

Even as I speak, the same management is now working out how to cut spending in real, historic and any other term you wish to use. The bucket still leaks as much. The level will drop. Waiting times will creep back up. Hospitals will close and management will blame it all on the government and most of you will believe them.