Where has the money gone?

I write as one who has had recent experience of the hospital part of the NHS, full of appreciation for staff working very hard, with kindness and cheerfulness.

The NHS was constructed hurriedly 60 years ago, in the conditions prevailing then - population size, medical technology, age of population, etc. A difficulty is that the structure is regularly tinkered with, but the basic structure has not changed with conditions.

The results are easy to see. Vast amounts of money have been spent over recent years, and yet problems remain, and some cases have worsened.

We leave aside the question of hospital acquired serious diseases which are killing more people than road accidents each year. The service is making little impact on the problem.

The Government's much vaunted claim that waiting lists are being reduced is misleading. They have thrown money at waiting lists, and 18 month waits for operations such as hip replacement are a thing of the past. However, since 1997 the average waiting time has increased from 41 days to 49 days. This is even true for serious conditions such as cancer.

The Office for National Statistics reveals that productivity is declining, at about 2% a year on average over the past five years. One aspect of this is that GPs, despite their enormous increases in salaries are actually seeing fewer patients each week, - in the early 1990s they saw over 120, and the figure is now under 90.

Dr. Le Fanu, writing in the Sunday Telegraph recently estimated that if GPs spent on average 7 minutes on each patient consultation, on four days a week, then each is seeing patients for about two hours a day. Unless his estimate of consultation length is out by a factor of three, which seems unlikely, it is difficult to see how the whole morning is occupied. Even if he spends his afternoons in specialist work such as maternity clinics, and in sick visiting, it seems likely that much of his time is spent in administration and in (government) form filling.

There is no denying that more money is being spent on the NHS. Where some has gone may be seen from the number of NHS (local) managers. Their number grew by over 70% between 1996 and 2006, at the time while clinical staff grew by merely 30%. From 200 to 2005 the number of administrative staff in the NHS grew by 40,000. All these have to be paid, some well paid by any standard.

The NHS is a large organisation, one of the largest employers in Europe. This year expectations are that the total NHS spending will reach £105 billion, a threefold increase since 1997 and one of the largest items on the Government's budget. The problem is that it is still being run like a corner shop, with all the decisions coming from one source. Any private business with the same turnover will increasingly have become decentralised for efficiency and to be in touch with its various markets.

The NHS is still being run bureaucratically from London, with duplication there of what is happening locally, and under instructions and policies run from Downing Street.

If we are ever to have a health service that is fit for the 21st century, then it too must be decentralised and sensitive to local needs. Otherwise demoralisation and waste and also declining productivity are likely to continue.