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The NHS lurches from crisis to crisis. In order to handle the Coronavirus epidemic, it has given up its role of providing healthcare in favour of its own self-preservation. The slogan SAVE THE NHS says it all. GP's, for example, now keep themselves safe by working three-day weeks of low hours for higher pay. In the meantime, they miss opportunities for early diagnosis of cancer, lung and heart disease to give just a couple of examples. Waiting lists for treatments are the longest ever.


It's said that we don't have enough doctors and nurses at a time when the number of staff employed by the NHS continues to increase. Official statistics1

list the number of staff in England as 1,193,666  in May 2021. This is 3.1% (35,926) more than in May 2020. But the government claims2 that: "There are record numbers of doctors and nurses working in the NHS in England. Provisional figures show that as of January 2021, there are a total of 123,813 doctors and 301,491 nurses working in the NHS".

Added together, these figures show 425,304 doctors and nurses from a total of 1,193,666 = 36%. It seems reasonable to ask what the other 64% are doing.


We also hear constant cries for more money. Yet official figures show that planned spending3 for the Department of Health and Social Care in England was £212.1 billion in 2020/21, up from £150.4 billion in 2019/20. This includes more than £60 billion of extra funding for the Department of Health and Social Care 2020/21 response to the Covid-19 pandemic. There is, clearly, no shortage of cash.


Yet we hear constant cries for more money while denying that business principles could play a role in a 'social service'.  I believe that both of these ideas are wrong.

They underline that, by focusing on its own wants and survival, the NHS has lost sight of why it exists.


I believe that we can and must apply basic business principles to our public health service. This is how.


Start by agreeing a definition of why the service exists. For example, to deliver health care to everyone in the country who needs it (patients).


Ask where this is delivered.  For example, in people’s homes, surgeries, clinics, hospitals, treatment facilities and research establishments. Call these Care Units.

Then accept that some patients need transport to these Units.


Describe key workers as those who transport patients to/from Care Units and those who deliver care in the Units. Call these workers Directs. All other workers are Indirects.


Define the desirable percentages of each Group e.g. 80% Directs - 20% Indirects.

Including ambulance and related workers, the NHS has approx. 52% Directs and 48% Indirects. Clearly, there are far too many Indirects. Note also that these are often paid more than the Directs.


Understand that the only Indirects who are really needed are those who support the Directs. Then interview every indirect worker in the NHS asking:

"As you don’t transport patients to Care Units and you don’t deliver care in those Units, explain why you are paid by the NHS".  Fire anyone not giving a satisfactory answer.


Do this for two years and compare the outcomes (including costs) with those at the start of the process. Repeat every four or five years.










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