Big state organisations look after themselves

Not an arresting opener, I grant you, but a solid truth that is also important. If it is true, it creates a presumption against "big government".

This is not about whether education should be "free", or healthcare should be "free". It is about whether governments are the best people to run these services.

In a historical context, it's amazing that they still do. No one would now argue that the nationalised British Steel made Britain world leaders in steel technology and production. Did our telephone system flourish under government control? We've abandoned the idea of nationalised industries, but to a great extent we still have nationalised education and a Nationalised Health Service (NHS).

The Conservatives are moving towards a less rigid model of education provision. So we may start to see that in a few years if the Crewe by election is a pointer to the future (though it may not be).

Proposals to dismember the unmanageable Nationalised Health Service are thin on the ground, and indeed the NHS is Mr Cameron's sacred cow. But the NHS is a huge state organisation, easily big enough to breed its own culture. Today's Financial Times shows how hospitals and primary care trusts have prepaid suppliers many hundreds of millions of pounds and have hidden money in other ways in order to keep the NHS surplus for last year down to the forecast £1.8bn, in case the Treasury tries to claw some back.

The chairman of one London hospital said it had not only been prepaying suppliers but also shifting money to charitable trustees to get it off the books by the end of the financial year. Some primary care trusts are also said to have prepaid local authorities for services.

Now, this is not just a one-off quirk in the NHS that our wise all-seeing ministers can easily sort out. The Scorpion remembers over ten years ago an approach to a German friend of mine by a German state organisation. They had the same problem - they looked likely to underspend for the year. So could they pay this year for the goods her company supplied and take delivery during the following year when they needed them? With pleasure, she said, but if they were so desperate to give her company cash in advance, they would have to pay it interest for the privilege. And they agreed.

And we know the NHS doesn't give us quality care. The best that can be said is that there is a very mixed picture on the quality of care in the NHS, and this evidence on quality raises questions about whether the gains have been value for money.

The main objective of NHS managers is to do enough to keep their jobs. If this means obstructing patient complaints, so be it. If this means running a dirty hospital, so be it.

In his book Squandered, David Craig reports the NHS's own estimate that 34,000 people a year die unnecessarily in NHS hospitals and a further 25,000 are unnecessarily permanently disabled. He says over 6,500 people a year die from hospital acquired infections, and suggests - sadly with no supporting evidence - that "we would only have 100 deaths a year if we could match the levels of some other Northern European countries". But doctors fudge the numbers. The Patients' Association reports that

Inaccurate reporting on death certificates is a constant feature of calls to our helpline. Bereaved relatives should not have to fight for accuracy, doctors have a duty to provide it.

If you want an example of how the clunking fist of the Nationalised Health Service can crush a man, you can read Who Cares? by Amanda Steane, his widow.

Paul Steane went into hospital with a minor problem – through repeated neglect in two NHS hospitals he emerged an invalid.

Throughout his time in hospital, his wife Amanda desperately tried to alert nursing staff and hospital authorities to the things that were going wrong with her husband.

Every time she alerted them to a new horror, they would promise that nothing like that would ever happen again – but every time things got worse.

Finally, an invalid deprived of his independence, his legs, his ability to communicate and everything he enjoyed, Paul Steane took his own life.

Inexperienced doctors, overworked nurses, filthy wards, inadequate care - all of these were guilty for Paul Steane’s death.

Hospital management denied all responsibility, claiming key parts of Paul’s medical records had been ‘lost’. But a nurse, outraged at what was happening, sent Amanda copies of the ‘missing’ records and the police began to investigate.

More than 30,000 hospital beds have been lost since Labour came to power, with record cuts in NHS wards last year. We now have half the number of hospital beds per 100,000 of population that they have in Germany, France or Holland, giving us a bed occupancy rate above 85% compared to 60% in some other European countries. Overcrowded hospitals are harder to keep clean. In the same decade that the beds were cut, death rates from the infections MRSA and Clostridium difficile rose five-fold. More than 2,000 maternity beds have been lost since 1997.

Ministers cling to the fiction that they have a grip on the organisation and they know best. How can a few ministers grip any organisation where the cost of the bureaucrats alone is over £722m a year? Indeed, how can anyone actually run such an organisation? It's impossible. There can be any amount of well meaning tinkering at the edges. But it won't change this core central fact.

The first priority of people in big state organisations is always to look after themselves. This was true even under Stalin, when his hand could reach anywhere into the organisation at any time and send its members to the gulag. It's also true in the Nationalised Health Service, where managers fired for killing people just get big pay-offs. It always was true, and it always will be.