Five Myths About The NHS

Suddenly , with the NHS in crisis, everyone seems to have an opinion about it and in particular just how it needs to be reformed. Now, I’ve only really begun to get to grips with the politics and economics of the health service through writing this newsletter in the past year, although as someone with two. long-term conditions I have plenty of experience of what it is like to be an NHS “customer.” But in this passionate and often angry debate about an institution we all care deeply about, I can’t help noticing a lot of myths keep cropping up, from across the political spectrum.

MYTH 1 - TOO MANY MANAGERS

From left to right there seems to be common agreement that everything would work better in the NHS if you got rid of vast number of managers. To the left, they are overpaid penpushers taking resources which would be better spent on frontline staff. To the right, the answer is to sack all those people with “woke” titles such as diversity and inclusion managers. But whether or not the right people are employed in the right jobs - and sacking people with “woke” titles would have a virtually invisible effect on spending - the claim that the NHS is over-managed is nonsense. Managers make up around 2% of the workforce, as compared with just under 10% across the economy as a whole.

The health service probably needs more strong leaders at every level but one issue is that clinical staff are often strong, independent minded individuals who resent being managed. A great friend who was an eminent consultant physician was asked from time to time to act as Clinical Director at his hospital - a senior management role. He hated it:

“My colleagues - the doctors - would see my decisions as purely optional for them,” he explained. “It was like herding cats.”

MYTH 2: ALL PRIVATE INVOLVEMENT IN NHS IS BAD

A Twitter account which campaigns against NHS privatisation ran a poll recently asking “would you end all health service contracts with private companies ?” The idea that any private sector involvement in health is wicked is just nuts. Yes, there are some outsourced activities such as cleaning that might benefit from being brought in house again but do we really want the NHS to run its own construction operations or cybersecurity division or even start its own pharmaceutical business? And while we may be properly sceptical about the motives of Big Tech, shunning any involvement with the kind of healthtech advances being explored by the likes of Microsoft, Google and Apple would not be in the interests or patients.

MYTH 3: ANY INNOVATION WILL COME FROM OUTSIDE

From the other end of the political spectrum the idea that the NHS is incapable of innovation and should leave it all to the private sector is similarly wrongheaded. More than a decade ago I started writing about GDS, the Government Digital Service , which brought teams of software developers inside Whitehall departments. This was a partially successful attempt to make digital innovation in government more nimble and avoid the situation where a civil servant hands a billion dollar contract for a major IT project to a tech giant without any understanding of what’s involved.

So we need that kind of expertise inside the NHS and we also need innovators who can straddle both health and technology, public and private sector. People like Moorfields Hospital’s Dr Pearse Keane who has worked with DeepMind to develop an algorithm to triage eye scans, or Giuseppe Sollazzo, head of the NHS AI Skunkworks.

MYTH 4: THE NHS IS A MONOLITH WITH A DATA GOLDMINE

This is a myth that is true, until you dig a little deeper. Yes, the NHS is one of the world’s biggest health providers with an almost unrivalled store of patient data. But it isn’t quite the monolith it appears - as well as the fact that health is a devolved area so Scotland and Wales run their own health policies, individual hospital trusts guard their own independence quite fiercely. This can be positive - anyone who’s worked in a monolithic organisation knows how slowly they can move - but also leads to a reluctance to learn from best practice and to share information. And when it comes to data it means this precious resource, rather than being a goldmine, is often locked in safe deposit boxes by trusts and GP practices, afraid or unwilling to share it.

MYTH 5: CUT IMMIGRATION TO SAVE THE NHS

My final myth is the daftest of all, as expressed in this tweet by the pressure group Migration Watch:

Migration Watch @MigrationWatch

Pouring cash into the NHS is futile if the sky-high immigration of the past 20 years continues. A huge inflow means a massive population growth and insatiable demand for healthcare. Cutting immigration is the only way to reduce pressure on the NHS.

Wherever you stand on the politics of migration this just doesn’t add up. Two of the biggest challenges facing the NHS are an ageing population and a shortage of trained staff. Migrants tend to be young people unlikely to make much use of the health service and often eager to find work in the NHS. So cutting immigration is likely to increase rather than cut pressure on our health service.