Politicians can't run hospitals

It is good to see a debate about the structure of the NHS. Dr James Lefanu rather sweetly calls for a return to the 1970's when disinterested professionals ruled the NHS. This for an employer of 1.5m people costing huge amounts of taxpayers' money, with major conflicting claims on its cash pot.

Charles Moore does a bit better in claiming that the health service cannot put the sick first because its client is the government. He suggests emulating the French system, under which hospitals compete. This would be attractive if all hospitals offered the same services. But they don't. All illnesses have to be treated - maybe more of them in specialist units. It's not clear how hospitals would compete simply.

(And competition doesn't always work as the central planners think it will - Richard North explains here why he thinks out-sourcing hospital cleaning on a price basis will never work.)

Nonetheless, the French system is an interesting comparator. This blog knows of a French hospital which for one illness is a world centre of excellence, and it is still as clean as a new pin. The French system may be unaffordable. But that may not be because its hospitals are clean!

If you separate the purchaser (the state) from the provider, at least you avoid the culture of NHS management who paid Rose Gibb £250,000 of taxpayers' money to go away when they knew she was about to be criticised yet again. This is contemptuous of patients and contemptuous of taxpayers. It has been claimed this is a private matter between Ms Gibb and her employer. It isn't. If Tesco gave a big severance payment to a manager who had been responsible for killing nearly 100 of their customers, the shareholders would be up in arms. In the case of a nationalised industry we are all shareholders.

As well as the complacency of insulated management, there is another lesson to be drawn. Local criticism of the unspeakable Ms Gibb carried no weight at all. She had been running dirty hospitals for years, but no local pressure could improve things under this serial killer.

At her trust, staff tried in vain for three years to get hospital bosses to tackle C-diff with more nurses and cleaners. Campaigner Geoff Martin said: "Staff reported a culture of bullying. If you spoke out you were told shut up or lose your job. Managers refused to listen."

(Incidentally, her partner also had a bad record running Barking, Havering and Redbridge Hospitals NHS Trust. )

Looking back through this blog, it's striking how many recent posts have highlighted poor performance of the labour-intensive nationalised industry that is the NHS - for instance on deep cleaning and poor treatment of the elderly, or the decline in NHS efficiency since 1997, or poor survival rates for cancer patients and stroke victims.

As we have argued before -

Medics sometimes call for "Tesco management" of the NHS. No Tesco manager would take this on. The Nationalised Health Service is too big and too complicated for anyone to manage effectively, even if they were freed from interventions by politicians (and medics?).

There is a stark choice: break up this nationalised monolith, or continue to pour taxpayers' money down the drain.

Meanwhile, people die because politicians are so puffed up that they think they can run hospitals. They can't.

The patients who died are martyrs to the vanity of politicians.