The Welfare State We're In, The website of the book by James Bartholomew
November 12, 2010
Friday
Spend, spend, spend

Martin Durkin's programme on Channel 4 last night certainly did not hold back. It was dramatic and powerful. It had some clever footage at the beginning with politicians repeatedly saying they were going to "spend", "spend" and "spend". This was followed by analysts and former chancellors drily saying that government did not have any money of its own. It was all the public's money.

I particularly enjoyed some of the visual demonstations of otherwise dry figures. There was a tall, transparent tube. Its total height represented all public servants - said to be seven and a half million. Then along came people dressed as representatives of the different front line services: a nurse, a policeman and so on. Each came with a bucket of liquid representing how many of them there are. After all of the liquid representing the front line services had been poured in, the measure had only reached just under two million people - and that included those employed in the private sector.

"So what do the other five and half million people do?" asked Durkin. There was then a mock quiz show based on "what's my line?" in which a panel tried to work out what jobs people did - often involving words like "consultant" and "coordinator".

Added 12th November 2010. It seems one can catch up on the this programme for nearly a month on this link: http://www.channel4.com/programmes/britains-trillion-pound-horror-story/4od

Posted by James Bartholomew • Indexed in Waste in public services

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July 20, 2010
Tuesday
A classic of waste in public services

Here is a remarkable story of waste of resources in a publicly run service:

Just one in ten police officers is free to tackle crime at any given time because the vast majority are either off work or tied up on other duties, a watchdog report has disclosed. In some parts of the country, as few as one in 16 officers is available to see the public or pick up the phone when a victim of crime calls.

The report, by Sir Denis O'Connor, the Chief Inspector of Constabulary, also found on any one day there are just 5,000 officers across the country ready to respond to emergency 999 calls, raising fresh concerns over the police’s ability to protect the public.

The picture emerged in a detailed study of the current state of policing and its ability to survive forthcoming cuts.

It found that the average beat bobby spends fewer than half the days of the year on duty and questioned management decisions after it emerged there are regularly more officers available for duty on a quiet Monday morning than the peak hours of a Friday night.

The full story was on the front page of the Telegraph.

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July 05, 2010
Monday
Waste of resources in the NHS
The study of 400 NHS operating theatres found that last year, less than 50 per cent of time scheduled for operations was actually spent performing surgery.

In orthopaedics, the biggest specialty, just 45 per cent of "operating time" was spent on surgery, while 33 per cent of time was lost to late starts and decisions to stop work early.

In ophthalmology, only 40 per cent of allocated time was devoted to operations – while 37 per cent of time was wasted at the start and end of the day.

Gaps between treating patients, cancelled operations and gaps on the surgery lists accounted for thousands more hours wasted.

The study by the NHS Foundation Trust Network examined detailed timekeeping records kept by clinical teams at 40 NHS trusts, as they performed 26,000 operations.

This story was from the Telegraph. What would be really useful, of course, is a comparison with other hospitals. How do private hospitals fare here and in other countries?

Posted by James Bartholomew • Indexed in NHS • Waste in public services

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One reason why state schools tend to fail their students
Only 18 useless teachers axed in 40 years despite '17,000 failing staff' in our schools.


From the Mail.

An organisation that does not sack some of it members has fallen under the control of the 'producer interest'. It serves its staff as a priority of serving its customers - the children.

Posted by James Bartholomew • Indexed in Education • Waste in public services

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June 22, 2010
Tuesday
What Labour did to the benefits system

Whatever else Labour did, they certainly made benefits more complicated.

The Child Poverty Action Group annually publishes the Welfare benefits and tax credits handbook.

How many pages do you need to read to get the picture? Well, I just bought the out-of-date 2009/10 edition because I could buy it much cheaper, second-hand, than its cover price of £37.

The total number of page is 1,601. The benefits system has become ludicrously complex.

Posted by James Bartholomew • Indexed in Reform • Waste in public services • Welfare benefits

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June 19, 2010
Saturday
Stunning figures to demonstrate causes of low productivity in state services

Policy Exchange has dug out some remarkable statistics in looking at how public services have developed in recent years. It is a story of the 'producer interest' writ large. Public services have a greater tendency than companies to indulge the producer interest. Companies have to compete to survive to indulge its servants. Public services do not.

It is embarrassing to sack someone for being no good at his or her job. You avoid it if you can. If there is a desperate need for an organisation to perform well to survive and remaining profitable, the bullet is bitten. People are sacked. But in the public service, there is no such driving imperative. So incompetent or lazy people keep their jobs. The 'producers' don't suffer. The consumers and those who pay for the service suffer instead.

Here are some of the figures which back up this argument:

Over the last decade the redundancy rate in manufacturing or construction has been seven times higher than in the public sector, roughly defined. During the recession these multiples increased to 16 and 10 times respectively. In a large survey of 60 different public sector organizations coordinated by the Cabinet Office, just 13% of employees disagreed with the statement that their organisation “is too lenient with people who perform poorly here.” The Civil Service is the most extreme example of this. Less than 1% of civil servants take voluntary redundancy each year, and compulsory redundancies are even rarer, affecting less than 0.00007% of the workforce a year. Job security can be seen as a benefit for the individual worker, which might be worth a certain amount of salary.

There are many other bits of remarkable information on the pay of managers and so on in the Policy Exchange report.

This is the press release.
This is the entry point to the full report.

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June 09, 2010
Wednesday
The fallacy in the 'front line services' idea

One of the key reasons that state-run bodies tend to provide less in the way of service at a greater cost is the waste that tends to build up in them over the years.

People are usually aware, though they may not like to admit it, that this is true. So you have politicians declaring at elections: "we will maintain/increase the front line services".

So what are the 'front line services'. They are the services of people like nurses, who actually treat the patients. These nurses are contrasted with the bureaucrats who do lots of paperwork which, it is implicitly accepted, involves a lot of work that is not really as necessary or important as the nursing work.

So the Labour government used to boast that it had increased the number of nurses. That is doubtless true. However, what if it also, at the same time, changed nurses into semi-bureaucrats? You could say, increase the number of nurses by 15% but increase their paperwork time from, say, 25% to 45%. In doing so, their front line time would be reduced from 75% to 55%. That, if you are still with me, would me a 26.7% reduction in their front line work, per person. So, overall, even after the increase in the number of nurses, the amount of 'front line' work would fall.

The numbers I have used are not the real numbers, just an illustration of how this is possible. Here, then, is an indication of the actual proportion of time nurses may now be spending on paperwork, given by the new Health Secretary, Andrew Lansley:

“They often spend just 50 per cent of their time interacting with patients, and in some cases as little as 35 to 40 per cent, because of bureaucracy and the shift system.”

The Royal College of Nursing has repeatedly warned that nurses were being bogged down by the weight of administrative duties.

In 2008 nursing staff across England spent more than a million hours a week on paperwork, the union found, time it said could be better spent tending to patients.

A survey of nurses also showed that most believe that the administrative burdens placed on them had increased over the past five years.

The full article is in today's Daily Telegraph.

This story is a possible lead as to how it was that such a vast amount of extra money was poured into the NHS by the Labour government resulting in a relatively modest improvement in the performance of the NHS.

Posted by James Bartholomew • Indexed in NHS • Waste in public services

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March 26, 2010
Friday
NHS managers up 84%

NHS total staff 1.43 million - up 30% compared to 1999.

Managers 44,600 up 84%
Administrative and technical support staff up 40%
Nurses 375,500 up by 'a quarter'
Junior doctors up by 'two thirds'
GPs up by 'nearly a third'
Consultants up by 'more than half'

These figures quoted in the Telegraph show that the fastest growing category of people in the NHS has been that of managers. They are ones who are well paid and do no front line work curing or caring for patients.

The Telegraph article does not make it clear where the data comes from.

Postscript:

Here is more information from the coverage in the Guardian,

The number of managers in the NHS in England rose by nearly 12% last year - more than five times the rate at which qualified nurses were recruited, sparking concerns that cash was being diverted from frontline staff.

Despite claims that NHS bureaucracy has been cut the health service has seen an explosive growth in management. The survey shows that the NHS now employs 44,660 managers and senior managers - an annual average increase in their employment of 6.3% over the last decade. This is faster growth than consultants, doctors, nurses and midwives.

A census by The NHS Information Centre reveals staff numbers reached 1,432,000 in 2009 - an increase of 63,300 (4.6%) on the previous year. It represents a steep acceleration in hiring. Staff numbers have grown by 2.7% on average every year over the last decade

Posted by James Bartholomew • Indexed in NHS • Waste in public services

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March 25, 2010
Thursday
Civil servants don't sack themselves, they sack cleaners

All the main parties claim they will cut public spending. But whose jobs will go? It ought to be those of the civil servants doing work which may be desirable but is not absolutely necessary. But it is the civil servants who will be doing the sacking. They won't want to sack their own kind.

Here is a warning passage from a parliamentary debate in 1980, when cuts were being pushed through with more determination than is likely by any of the current political parties:

We have been assured on a number of occasions that, wherever possible, cuts in Civil Service manpower will be achieved through natural wastage rather than redundancies. In this instance, clearly there was a good deal of pressure on the Ministry of Defence to cut numbers, partly because it employs about one-third of the total number of civil servants. Against that background the cleaners may seem to be an easy target. After all, in the Government's statistics, as in the divine plan, one Mrs. Mopp counts the same as one permanent secretary. In this instance the axe was not spared, and it fell not on a single deputy secretary, under-secretary, assistant secretary, senior principal or principal, but on just under three and a half score cleaning ladies. It is not surprising that one or two of my constituents have suggested that the whole episode sounds as though it comes from the television programme—which I have not managed to get home in time to see—called "Yes, Minister".

The speaker was Michael Heseltine.The link is here.

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December 16, 2009
Wednesday
Regulations may damage our health

This is an old blog post but illustrates the point that government regulation can actually do harm. In this case, the harm is that valuable time of doctors is used filling in government forms rather than treating patients. Link here.

http://nhsblogdoc.blogspot.com/2007/03/crippen-diaries-2007-11.html

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November 13, 2009
Friday
Talking donkeys have victims

The newspapers in the past few days have been stuffed like a Christmas turkey with articles illustrating the waste that takes place in publicly-owned services:

- the Ministry of Defence employs about one civil servant to every 2.25 members of the armed forces.

- the government intends to prohibit anybody without a university degree from becoming a nurse, thus increasing the cost of each nurse and reducing the number of years he or she will work.

- the top 100 staff of the BBC are paid £20m a year plus bonuses and entitlements.

- the police have issued a 93 page booklet informing its constables how to ride a bicycle.

- the European Union has sponsored a talking donkey.

These things are even worse than they appear:

- the money that is wasted in this way cannot then be spent on things that are actually important like more soldiers and sailors, better equipment for them and more nurses. There are already shortages now in all these areas. Nurses are already rushed off their feet and unable to give satisfactory attention to patients. This is bound to get even worse as a result of the university rule. The shortages of men and equipment in the army have been prominent in recent news.

- Secondly tax has to be raised to pay for the waste. This tax is levied on poor people, too. The government already demands taxes of those people whom it defines as being in poverty. The extra tax also means extra discouragement to those who might otherwise move from benefits dependency to employment. Without work, they have less hope and self-respect. And the cost of any decision to stay on benefits means extra taxes on those remaining in work.

Waste in public services is normal. It always happens, sooner or later. And it is not a victimless crime.

(Extract from the Daily Mail

The Ministry of Defence by numbers

85,700 civil servants at the ministry
113,000 personnel in the Army
38,400 in the Royal Navy
41,400 in the RAF

So according to these figures, there are 192,800 members of the armed forces and there is one civil servant for every 2.25 members of the armed forces.

Posted by James Bartholomew • Indexed in NHS • Waste in public services

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October 30, 2009
Friday
Press officers galore

Every six months, the government produces a list of the press officers of the various government departments. It is called "The White Book". When I first used this book many years ago - certainly more than 15 - it was a modest little affair that was stapled together. I remember being impressed by how few staff were press officers for the Treasury despite its great importance. I think it had between about seven and nine press officers. I wrote about economics at the time and got to know some of them pretty well.

The latest White Book published in September has 206 pages - the size of a short novel. The number of pages is up from 198 in the March edition - so much for the government holding spending on everything apart from 'front line services'. Naturally staples would not hold those pages together so it is bound like a paperback. The Treasury now has 19 press offices and a further 17 who work for "Publishing and internal communications" and the "Correspondance and enquiry unit".

But the Treasury remains one of the leanest of the press offices. The Department of Health has 145 press officers and this does not include press officers for the Health Protection Agency, NHS Blood and Transplant, NHS Counter Fraud and Security Management Services or the NHS Institute for Innovation and Improvement and doubtless other agencies which are health-related.

There are about 197 full page listings in the booklet and, at a rough estimate, about 20 press officers per page (some room is needed to fit in their grand titles with words like 'head', ''chief', 'strategy' and 'senior' liberally sprinkled around). So that is about 3,940 press officers - and this is exclusively for national government. I wonder how many journalists are left in Fleet Street to ask them anything? It may be a staff-to-customers ratio that the Ritz would envy.

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October 26, 2009
Monday
Where the NHS money goes

Essential reading for understanding how the NHS receives a lot of money from government but is always short of it for spending on healthcare.

There is a very similar story to be told in education, too.

Posted by James Bartholomew • Indexed in Education • NHS • Waste in public services

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October 13, 2009
Tuesday
The evil deals done between producers and governments

Here is an article on the 'producer interest' with an interesting section on how those who are pursuing their interest use governments to further them, to the disadvantage of the public interest.

Posted by James Bartholomew • Indexed in Waste in public services

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October 12, 2009
Monday
MPs and the 'producer interest'

The expenses of MPs about which the public is expressing renewed anger were classic examples of the 'producer interest' in which employees in any organisation tend to start thinking of their own advantage to the disaadvantge of those they serve. (See previous posting.) When people can feather their nests, they often will. That is human nature unless there is a counteracting force such as the need to make a profit in a business, powerful peer pressure or a moral upbringing that would be unusual in modern Britain.

The worst of the nest-feathering, though, among MPs perhaps does not consist of the expenses. It consists of their pension arrangments.

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Mrs Shoesmith and the "producer interest"

It is the glaring contrast that makes one blink in disbelief. One the one hand, a child is dead who should have been saved. The department that should have saved her is described by Ofsted as “almost universally terrible”.

On the other hand, as if all this were totally irrelevant, the former head of the local authority department in question, Mrs Shoesmith, is described by her boss as a “heroine” and given a reward for her performance. She is only sacked after a public outcry. It is as if public servants lived in an Alice in Wonderland world of their own. Performance that looks disastrous in the real world looks terrific – no, ‘heroic” - in theirs.

When we first heard about the praise given so wholeheartedly to Mrs Shoesmith, our first reaction was probably to think, “How bizarre!” and write it off as an aberration. But it is not. It is just an extreme example of something as common as bills being paid late and men looking at pretty women.

I travel on the London tube occasionally and am always struck by an infuriating announcement that goes along the lines of “The Central Line is running thirty minutes late because of a signal failure at West Acton. The Northern Line is not operating currently and the Circle Line is subject to delays. Otherwise all lines are operating a good service.” [My italics.]

The self-congratulation is unattractive and absurd. They live in their own self-regarding bubble. Imagine you are in a Tesco supermarket and someone announces, “There is no milk today due to a delivery failure from Gloucestershire and there is no bread due to a getting-up-in-the-morning problem encountered by one of our staff. However we are offering a good service in baked beans and tinned prunes.” It never happens, does it? Why not?

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June 01, 2009
Monday
Suggested questions for Messrs Humphrys and Naughtie

Those who find the constant drip of anti-capitalism from most of the presenters on the BBC Radio 4 'Today programme' aggravating now have a more bearable alternative: Radio 5 Live, despite also coming from the BBC, generally has more open-minded presenters. Nicky Campbell is certainly not anti-capitalist and is able to ask questions which seem wholly beyond John Humphrys and Jim Naughtie on the Today Programme. True, there is a certain Left-wing bias to the questions of a chap called Bacon, but he is not usually around in the morning, I think.

Despite all the evidence, I still hope that one day the Today Programme might reform. In case the producers finally decide that the interviewers should sometimes ask questions from a free market viewpoint instead of always a Left-of-centre one, I offer some suggestions:

TO BE PUT OVER THE MIRRORS OF JOHN HUMPHRYS AND JIM NAUGHTIE

"Wouldn't this problem best be left to the market?"

"Government service + monopoly = bureaucracy + bad service + rationing. Which part of that do you disagree with, minister?"

"Since this government service has done so badly, does it make sense to throw more taxpayer's money at it?"

"Is it responsible to raise taxes when you know - or should know - that all taxes have bad unintended consequences?"

"We know what all this extra public spending will lead to don't we, minister: more waste of taxpayer's money, more index-linked pensions and early retirements, less productivity..."

"The government already taxes people whom it defines as being 'in poverty'. Is it morally right to add to those taxes?"

And here is a long one, especially for Jim:

"Since the government already taxes poor, elderly people, any further spending by government has to face a severe test: it has got to be more worthwhile than reducing the taxation of the poor. Your idea [for letting off fireworks/keeping an out-of-date car factory going etc etc] does not pass this test, does it minister?"

Further suggestions welcome.

Posted by James Bartholomew • Indexed in Media, including BBC bias • Tax and growth • Waste in public services

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May 28, 2009
Thursday
Why are government services so bad and wasteful?

Here is a pretty good answer. It is by John Steele Gordon in the Wall Street Journal on May 21st. (I have edited it a bit. The full article is here.)
http://online.wsj.com/article/SB124277530070436823.html#mod=todays_us_opinion

1) Governments are run by politicians, not businessmen. ... Because of the need to be re-elected, politicians are always likely to have a short-term bias. What looks good right now is more important to politicians than long-term consequences even when those consequences can be easily foreseen. The gathering disaster of Social Security has been obvious for years, but politics has prevented needed reforms.

And politicians tend to favor parochial interests over sound economic sense.

2) Politicians need headlines. And this means they have a deep need to do something ("Sen. Snoot Moves on Widget Crisis!"), even when doing nothing would be the better option. Markets will always deal efficiently with gluts and shortages, but letting the market work doesn't produce favorable headlines and, indeed, often produces the opposite ("Sen. Snoot Fails to Move on Widget Crisis!").

3) Governments use other people's money. Corporations play with their own money.

So a labor negotiation in a corporation is a negotiation over how to divide the wealth that is created between stockholders and workers. Each side knows that if they drive too hard a bargain they risk killing the goose that lays golden eggs for both sides.

But when, say, a school board sits down to negotiate with a teachers union or decide how many administrators are needed, the goose is the taxpayer. That's why public-service employees now often have much more generous benefits than their private-sector counterparts. And that's why the New York City public school system had an administrator-to-student ratio 10 times as high as the city's Catholic school system, at least until Mayor Michael Bloomberg (a more than competent businessman before he entered politics) took charge of the system.

4) Government does not tolerate competition. The Obama administration is talking about creating a "public option" that would compete in the health-insurance marketplace with profit-seeking companies. But has a government entity ever competed successfully on a level playing field with private companies? I don't know of one.

5) Government enterprises are almost always monopolies and thus do not face competition at all. But competition is exactly what makes capitalism so successful an economic system. The lack of it has always doomed socialist economies.

When the federal government nationalized the phone system in 1917, justifying it as a wartime measure that would lower costs, it turned it over to the Post Office to run. (The process was called "postalization," a word that should send shivers down the back of any believer in free markets.) But despite the promise of lower prices, practically the first thing the Post Office did when it took over was . . . raise prices.

Cost cutting is alien to the culture of all bureaucracies. Indeed, when cost cutting is inescapable, bureaucracies often make cuts that will produce maximum public inconvenience, generating political pressure to reverse the cuts.

6) Successful corporations are run by benevolent despots. The CEO of a corporation has the power to manage effectively. He decides company policy, organizes the corporate structure, and allocates resources pretty much as he thinks best. The board of directors ordinarily does nothing more than ratify his moves (or, of course, fire him). This allows a company to act quickly when needed.

But American government was designed by the Founding Fathers to be inefficient, and inefficient it most certainly is. The president is the government's CEO, but except for trivial matters he can't do anything without the permission of two separate, very large committees (the House and Senate) whose members have their own political agendas. Government always has many cooks, which is why the government's broth is so often spoiled.

7) Government is regulated by government. When "postalization" of the nation's phone system appeared imminent in 1917, Theodore Vail, the president of AT&T, admitted that his company was, effectively, a monopoly. But he noted that "all monopolies should be regulated. Government ownership would be an unregulated monopoly."

It is government's job to make and enforce the rules that allow a civilized society to flourish. But it has a dismal record of regulating itself.

Capitalism isn't perfect. Indeed, to paraphrase Winston Churchill's famous description of democracy, it's the worst economic system except for all the others. But the inescapable fact is that only the profit motive and competition keep enterprises lean, efficient, innovative and customer-oriented.

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May 12, 2009
Tuesday
After the MP expenses scandal, politicians can no longer pretend they do not accept the concept of the 'producer interest'

One of the concepts that is vitally important to understanding why government services tend to develop low productivity is "the producer interest" - the tendency of those who provide a service to start thinking as much or more about their own interests as they do about their customers.

This is a concept that politicians themselves have had a tendency to brush aside. "Of course, doctors/nurses/policemen/teachers are far too decent and well-intentioned to behave like that," they say as if nobly defending the honour of individuals who have been unjustly slurred. Well, they can't pretend they don't understand the concept now. The politicians themselves have been found manipulating their expenses system to pay for the cleaning of their moats, the refurbishment of their houses and so on and on. They milked the system for their own benefit. The Daily Telegraph has been full of the gory details for the past five days or so. We paid more for our MPs than we realised. Their productivity was lower per pound. Money was wasted.

So my question is this: why do Members of Parliament expect doctors, nurses, policemen and teachers to be more upright, moral and public spirited than they are themselves?

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December 18, 2007
Tuesday
Administration, targets and regulations have made NHS care 'worse than five years ago'.

A few days ago, I met a consultant who told me patient care has become worse in the past five years. She mentioned a number of things that were worrying and/or were making the business of treating patients more difficult.

1. The NHS management has imposed an expectation that, in her speciality, there should be two follow-up meetings with patients for every one meeting with a new patient. This target varies from one speciality to another. Her target is, as far as she is concerned, wholly arbitrary and damaging to good patient care. She believes that good care requires, on average, a higher proportion of follow-ups. But if the hospital fails to keep to the proportion prescribed, then it will lose some funding. So an attempt must be made to keep to it or to fake it.
If they were to keep to it, then patients who needed to be seen more than twice after the initial visit would suffer. She suggested that therefore, in order to maintain good patient care despite the target, they fake it - at least some of the time. They call an old patient a new patient. Presumably they pretend that the patient has a new ailment whereas, in fact, it is the continuation of the old one.
How depressing it is that senior doctors have to spend their time getting around silly rules rather than devoting themselves to their job of looking after patients.

2. She told me that doctors gain the status of consultants far more quickly than before. Previously they spent four years training generally and then another seven years in their speciality. They also worked all hours, thereby seeing a great deal of illnesses and their treatment. Now, however, they can be called 'consultants' after only five or six years and they have had significantly less experience in those years than they would have done previously because of the new rules limiting their working hours. A consultant today is often not the highly experienced top doctor that he or she would have necessarily been in the past.

3. Another effect of the new working hours is that the new consultants more frequently than before have a shift mentality. When their time is up, they go home regardless of the state of their patients. This is a change from the time when a consultant very frequently felt his or her prime responsibility was to the patient and that this would quite often mean he or she would stay around until a procedure involving the patient was complete.

4. She told me that there is a drive for doctors to account for everything thing they do. She said that in one hospital, I think it might have been Great Ormonde's in London, they were trying out a system whereby doctors would account for each thing they did for patients on a personal digital assistant (PDA. I remarked that I had recently seen another consultant in a different hospital swiftly moving from task to task - ordering an X-ray for one patient, asking for another patient to go to his office, consulting with another doctor about a third patient, examining the second patient, looking at X-rays for a fourth patient, having a word with the relatives of that patient all in quick succession. If he had had to itemise such things, he would not have had time to do them. She heartily agreed. In trying to monitor such things, the administrators were going to damage the productivity of doctors and thus damage patient care.

5. She also remarked what a vast army of people there must be doing all the monitoring of targets. Somebody from her hospital would have to collate all the figures showing whether or not she was meeting the unnecessary and damaging target of two follow-up consultations for every one initial consultation. Then the information would have to be sent to the central administrators who would have to check and analyse the figures. I presume someone would have to decide if the funding should be cut. Letters and warnings would be issued and replied to. Someone must also have been paid who thought up the idea. Someone must have thought up how it should be implemented. Stationery would have been designed, printed and distributed to hospitals. And so on and on. One bad 'bright' idea. Hundreds more people employed by the NHS to produce no improvement in treatment. In fact their employment damages patient treatment since their wages and costs such as office space, heating, lighting, pension rights and so on have to be taken out of the NHS budget and taken away from patient care.

I had spoken to this consultant when researching The Welfare State We're In. She told me that she thought things in the NHS were bad then but they are worse now. She also remarked that having damaged the NHS, the regulators and administrators have also moved in on the private sector, requiring more and causing more damage even to the private sector.

6. There is a requirement now that hospital consultants can only do certain treatments if the hospital concerned has beds that are suitable for that particular speciality. Presumably this is in case there is a mishap and the patient needs a hospital bed. But the result is that hospitals where a consultant used to do minor treatments immediately and on the spot are not allowed to do this any more. In the past, the consultant could decide whether or not it was wise to do such treatments. Now he or she is not allowed to decide. The patient has to make a new appointment at a different hospital, quite possibly seeing a different consultant who has to learn about the case afresh. Patient time and care is damaged. More consultant time is wasted.

She painted a very depressing picture of how the NHS is being administered and how even the private sector is being interfered with and damaged by government.

Posted by James Bartholomew • Indexed in NHS • Waste in public services

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April 17, 2007
Tuesday
The NHS computer fiasco: why do governments keep wasting such vast amounts of money?

The simple point about the NHS computer fiasco is this: that governments repeatedly botch up major projects. The result is that huge amounts of money that could have been spent on patient care has been wasted.

Why do governments keep on wasting money on this spectacular scale? Because no one is truly both a) in charge and b) accountable. When Marks and Spencer was adrift and losing market share, the chief executive and many others got the sack and their reputations were damaged. No one has publicly got the sack for this vast waste of public money.

Here are some of the details as described by Richard Bacon M.P. in the Daily Telegraph today:

By now, almost every hospital in England is supposed to have key administrative software deployed as the essential first step in introducing the shiny new electronic patient record. They are miles behind schedule, yet the limited deployment has already caused havoc, with significant delays in providing inoculations to children, waiting list breaches, missing patient records and the inability to report activity statistics. Not to mention the trifling matter of the largest computer crash in NHS history, when 80 hospitals had no access to patient administration systems for four days.

This is a truly grim tale. More than £2 billion has been spent, and although there is no detailed record of overall expenditure on the programme, estimates of its total cost have ranged from £6.2 billion up to £20 billion. There have been six bosses in five years. Timetables are fictitious and the programme is now years behind.

Doctors, nurses and hospital managers have been left spitting with rage. Most GPs think the appointment booking system is a joke. And three fifths of the programme is dependent on a software supplier called iSoft, which is currently under investigation by the Financial Services Authority and whose flagship software product, "Lorenzo", does not exist yet (even though the company said it was available three years ago). In the meantime, iSoft has been merrily selling old software that pre-dates the national programme.

Today, Parliament's spending watchdog publishes a report on this multi-billion-pound fiasco, which concludes: "At the present rate of progress, it is unlikely that significant clinical benefits will be delivered by the end of the contract period." The whole project has been an object lesson in how not do it.


The full article is here.

The news story is here.

Posted by James Bartholomew • Indexed in NHS • Waste in public services

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March 22, 2007
Thursday
Over-employment in one of the state industries

Some people say, "Ah yes, governments may well waste money. But so does the private sector."

Of course this is true. There is waste in every kind of organisation. The key issue, though, is how much?

When it comes to employing more people than necessary to do a job, the public sector is in a different league compared to the private sector.

The old Central Electricity Generating Board used to employ 26,000 people. All of them, it would have been claimed at the time, were necessary to the production of electricity.

Five years after privatisation of the board, the two companies which the CEGB was turned into - National Power and Powergen - employed few than 9,000 people.

Electricity continued to be generated.

I am grateful to Colin Robinson for these figures.

Just think how many thousands of people, that poor people pay for through their taxes, are currently employed - but not actually necessary for the job to be done - in the NHS and in education today.

Posted by James Bartholomew • Indexed in Waste in public services

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March 21, 2007
Wednesday
Debate: Does public spending gives us enough bang for our buck?

In the wake of the budget, I will be taking part in a lunchtime debate tomorrow (Thursday) on the subject: "Does public spending gives us enough bang for our buck?". It will come no surprise to those who have read 'The Welfare State We're In' that I will argue that public spending tends to be extremely wasteful.

The debate will take take place at the Royal Society for the Encouragement of the Arts. (I am sorry to be disrespectful to the hosts of this debate, but I notice that the RSA appears to be another ancient charity whose original purpose is no longer respected. I rather doubt that the 18th century creators of the society would have subscribed to its current commitment towards creating a 'zero-waste society'. It is quite a modern racket, this taking over old charities and using the money to get an income and promote one's views.)

For a variety of entries on 'waste in public services', try this category in the list in the left-hand column.

Posted by James Bartholomew • Indexed in Charity • Waste in public services

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December 05, 2006
Tuesday
Re-offending up from 55% to 67% in the past five years

One of the contentions of The Welfare State We're In is that the welfare state has been a major contributor to the massive rise in crime and anti-social behaviour since the beginning of the 20th century. The problem is compounded by the fact that the state, in addition to being a bad supplier of welfare, tends to be a bad administrator of everything else it does, too. This applies to all aspects of criminal justice including investigation of crimes, prosecution, the courts and punishment.

The poor performance of the state in these areas exacerbates the increased crime for which the welfare state is largely responsible.

At the end of last month, Lord Ramsbotham, the former prisons chief, wrote a scathing attack on the administration of prisons in The Independent. It was significant because it came from such a well-placed soure.

This is part of what he wrote:

Yesterday's announcement that the prison population now exceeds 80,000 is the latest low point in what one can only describe as the Government's headlong and self-induced race to absurdity as far as the conduct of imprisonment is concerned.

He cites various reasons for this. The one that is particularly worrying is this:

If you do not resource prisons, to enable them to conduct work, education and training, prisoners are more likely to reoffend, as proved by the fact that the reoffending rate among adult males has gone up from 55 per cent to 67 per cent in the past five years.

That rise in re-offending seems remarkable and suggests, all by itself, that something may be going badly wrong in our prisons.

What could it be?

Posted by James Bartholomew • Indexed in Behaviour & Crime • Waste in public services

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November 10, 2006
Friday
This could irritate

A good article by Tom Stevenson about the amazing rise and rise of red tape. It matters because resources and efforts are wasted. We would be richer and freer with less government. The poor could do with the money and the rich could do with the freedom.

Posted by James Bartholomew • Indexed in Waste in public services

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June 08, 2006
Thursday
Wasting money in state education

From John Clare's column in the Daily Telegraph yesterday:

My son, who has just turned 16, is being urged by his school to sign up for a "Connexions Card". What's it all about?

Another Government black hole. More than a million cards have been issued over the past five years supposedly to encourage youngsters aged 16 to 19 to "keep learning". Holders collect "reward points" for turning up at school or college and then "spend" them on CDs, DVDs, mobile phone accessories or whatever the scheme's commercial sponsors are peddling.

As harmless - and pointless - as a supermarket "loyalty card", you might think. But so far, issuing the cards - which contain a chip storing the holder's personal details - has cost taxpayers £72 million, of which £66 million has gone to Capita, the Government's favourite private-sector dog'sbody.

What proof is there of any educational benefit? "There is no evidence that the originally intended impact on increasing post-16 participation in further education and training is yet being achieved" - Beverley Hughes, a junior minister in the Department for Education (with commendable honesty). Capita, however, has been told to carry on churning out the cards, for which it will be paid another £40 million between now and December 2008. Isn't it fun wasting other people's money?


Posted by James Bartholomew • Indexed in Education • Waste in public services

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June 06, 2006
Tuesday
The crass-mismanagement of the NHS: No job for newly qualified consultants.

I am sorry to quote the Daily Mail for a third time in one day. Why on earth does not every newspaper carry this story?

Scores of newly-qualified consultants are stuck without jobs because of mounting NHS debts, Britain's most senior surgeon has warned.

Bernard Ribeiro, president of the Royal College of Surgeons, said the predicted £1 billion deficit in the NHS has led to a 'vacancy freeze' for doctors who have passed their consultant exams.

This means dozens of trainee consultants are now facing unemployment or are considering retraining.

It amounts to a huge waste of taxpayers' money given that it costs £237,000 to get just one student through medical school.


Posted by James Bartholomew • Indexed in NHS • Waste in public services

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June 05, 2006
Monday
Politicians waste the money of the poor - this time it was Tony Blair and NHS computerisation

It is a truth, insufficiently acknowledged, that whenever the central government organises something, it wastes money and people. The cost is borne by taxpayers who, these days, include many who are relatively poor. It therefore follows that the process of having the government organise things is automatically to cause the relatively poor to be taxed more heavily.

The most extreme, single demonstration of the waste perpetrated by government is the computerisation of the NHS. The whole appallingly wasteful exercise, costing billions of pounds to taxpayers, appears to have started with the wholly ignorant, amateur idea of one politician: Mr Tony Blair.

Here, from the Sunday Telegraph yesterday, is an account of how he made this very important decision and how effective the actions he started have been:


Elated by the prospect of prescriptions pinging into patients' e-mail accounts, of ridding surgeries of yellowing records and A&E departments of carbon paper, Mr Blair, according to one observer, had "a Tony moment". With a wave of his hand, he gave the go-ahead for the biggest public sector IT project the world has seen - a scheme which has now become one of the biggest IT turkeys the world has seen.

The plan would link more than 30,000 GPs with 300 hospitals. "Up to 600 million pieces of paper a year" would be saved, Mr Blair promised. Patients' notes would be available in any hospital at the click of a mouse, and GPs would be able to book hospital appointments over the internet ("choose and book"). The Prime Minister even joked about making GPs' handwriting "legible for the first time in history".

Four years later, the joke is on Mr Blair, and the taxpayer. The "Connecting for Health" project is two years behind schedule and more than three times over its initial £6.2 billion budget. Lord Warner, the health minister, revealed this week that the real cost of the programme would approach £20 billion by 2010, its revised delivery date.

Posted by James Bartholomew • Indexed in NHS • Waste in public services

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May 08, 2006
Monday
Failing state education on a spectacular scale

Gordon Brown would like to send taxpayers' money to provide more education in Africa, by which he means more state education. There are far better ways of helping Africa. Below is part of an article in yesterday's Sunday Telegraph. It graphically describes how money put into state education in Pakistan has been wasted on an astonishing scale.

Of course Africa is not Pakistan. But it is hardly renowned as a place where government corruption is unknown. And James Tooley's Newsnight report from Africa last year indicated that, on the contrary, money spent on state education in certain countries there was by no means well spent.

If poor people in Britain were taxed in order to hand over their money to African government to waste in anything like the way described below, it would be appalling.

Millions of children in Pakistan are denied even a basic education because of wide-scale corruption and inefficiency in the state system, an independent watchdog has revealed.


At one school, the playground is so full of rubbish dumped by neighbours that the stench is too foul for children to play, in another, the classrooms are used to store grain and at a third, 49 teachers draw salaries even though there are no pupils.

Yet a report by the Human Rights Commission of Pakistan claims that such cases are far from unusual, and that state education is so crippled by graft and its accounts so poorly monitored, that millions of pupils are receiving no meaningful education. About 40,000 "ghost schools" stand empty or are used for other purposes.

Of the often-squalid, crowded schools where teachers and pupils do actually meet, more than 60,000 (39 per cent) have no drinking water, 96,000 (62 per cent) have no electricity and 76,000 (49 per cent) have no lavatories, the report, published last month, reveals.

At Karachi's Haqqani Chowk School, 49 teachers are on the payroll, costing the school £7,170 a month, but no pupils are registered. At another primary school in the city, 40 teachers have been appointed to teach only 11 enrolled children.

"Most of the teachers in public-sector schools have secured postings to institutions where they need not attend every day, and at least 50 per cent of the teaching staff in public-sector schools are 'ghost teachers'," said Abdul Wahab Abbassi, a senior education official.

The absentee teachers handed between 30 and 40 per cent of their salaries to district education supervisors to ensure that they kept their "jobs", Mr Abbassi added.

In Sindh province, of which Karachi is the capital, 3,228 school buildings are used as autaqs - gathering places for men - or for grain storage, and their playgrounds as livestock pens.


Posted by James Bartholomew • Indexed in Education • Foreign aid • Waste in public services

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April 24, 2006
Monday
How the NHS has wasted the extra money

The reason why so much new money has done relatively little for the quality of the NHS is that so much has been wasted. This is part and parcel of how state monopoly services tend to operate.

One of the ways in which money has been wasted in the NHS appears to be in paying GPs more than is necessary to retain their services. Of course it is also true that the NHS has increased the amoung of money that is necessary to retain their services by making the job less satisfying and more bureaucratic. So there has been a double-whammy of extra cost.

This is from a good article in the Sunday Telegraph detailing quite a few examples of waste in the NHS:

There is no doubt that GPs have been the biggest winners of the boom in NHS spending, which has increased by £22 billion over the past four years. In 2003/04, the last year before GPs were put on to new performance-related contracts, they worked according to a contract that gave them an intended annual income of £61,000.

This year, admits the BMA, GPs are taking home an average of £94,000 a year, making them the best-paid in the world outside the United States. Moreover, many have simultaneously managed to cut their workload dramatically. Until 2004, GPs were responsible for 24-hour care of their patients. They didn't have to be on call at night, but if they opted out they were obliged to provide cover out of their own pockets.

Under the new contracts, by contrast, GPs can opt out of being on call at weekends and during evenings by giving up just £6,000 a year of their pay. But they can quite easily more than make up for this in other ways. GPs are now paid on a points system called the Quality and Outcomes Framework. Points, each worth £125 a year, can be earned, for example, by monitoring diseases and providing advice.

For example, GPs can earn an annual bonus of £8,472 if they record whether patients with heart disease or asthma are smokers and offer them advice on giving up smoking. Compiling a register of diabetics, taking their blood pressure and treating their symptoms can earn a GP a further bonus of up to £11,587.

"The system was predicated on the basis that GPs would get 700 or 800 points," says Dr James Le Fanu, a GP for 20 years. "But it quickly became clear that it was not very difficult to start getting 1,000 points a year, which is where salaries of £125,000 a year come from. What's more, GPs are earning this extra money for doing things that they should have been, and most were, doing anyway. Paying GPs to meet targets is a very bureaucratic view of what the health service should be about. Being a GP is not just about measuring blood pressure. It is about sitting down with people and talking to them."

Posted by James Bartholomew • Indexed in NHS • Waste in public services

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April 03, 2006
Monday
Government waste, it seems, even extends to libraries.

Richard Charkin, a publisher, has a blog and this is part of an entry from it about Tim Coates, the former managing director of the bookshop Waterstones:

He is currently involved in a highly personal campaign to encourage the British Government and local authorities to spend library budgets on books - a simple, obvious but difficult objective. Not everyone agrees with Tim's in-your-face approach to campaigning but at the very least he has made the topic unignorable. I asked him to write a guest blog for me and here it is:

"Half the management in this country is public sector. The rules are different: income does not depend on judgment, efficiency or perfomance; cash is available; there is no such thing as bankruptcy and nor are there the disciplines, anxieties, skills and systems which are used to avoid it. Employment is secure and very well paid. Projects thrive on persuasive plans but rarely on actual outcomes. To a private sector manager, the regime is unfamiliar.

We have become used to the idea that only a small portion of charitable donations reach their intended recipients; we should get used to the idea that the great part of the money we thought was for public service will never reach any public beneficiary. We live in an economy which is the travelling equivalent of a crowded roundabout. Huge amounts of public funds travel on a journey which goes nowhere in an unpleasant and wasteful manner.

The full entry is here.

Incidentally, publishing is dominated by people who are left-wing and therefore, implicitly, believe that government is the answer to most problems. It is refreshing to see a few publishers who are open to the idea that, in fact, governments tend to be incompetent and wasteful. It would be good to have a bit more detail of the waste that Mr Coates has come across.

Posted by James Bartholomew • Indexed in Waste in public services

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March 25, 2006
Saturday
There are only two types of money...

"There are only two types of money: your own money and other people's money."

From a well-made article about how governments tend to waste money. It is by Ian Cowie in today's Telegraph.

Posted by James Bartholomew • Indexed in Waste in public services

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March 21, 2006
Tuesday
MIllions die because of government provision of water

We are regularly told in Britain that water is vital to the health of many millions of people in Africa and elsewhere. So it is. But never is it suggested that the reason there is such a problem with water in Africa is because water supply is run by governments, not private companies. That would be to undermine the 'government is best' assumption of virtually all broadcast media coverage in Britain.

Now, at last, comes a paper from the Globalization Institute putting the argument that millions of people in Africa have died because of this misguided belief that government is best.

These are the opening lines of the paper, by Mischa Balen, apparently a Labour Party activist:

Over a billion people worldwide do not have access to safe drinking water, and 2.6 billion people have no sanitation facilities. More than two million people die each year from diarrhoea, and over six million people are blind as a result of trachoma, a disease strongly related to lack of face washing. In Sub Saharan Africa, 42% of the population lacks access to decent water.

Other diseases which are caused by water poverty include scabies, typhoid and malaria. The need for clean water to prevent the spread of these and other diseases is therefore paramount.

This is one of the greatest problems humanity faces. It is a problem which is taking place under the auspices of the state sector: 95% of the world's population gets its water from state-run services. Government provision in water has overseen millions of deaths through poor quality and lack of sanitation.

Posted by James Bartholomew • Indexed in Foreign aid • Media, including BBC bias • Waste in public services

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January 24, 2006
Tuesday
Frank Field assert chronic maladministration of Incapacity Benefits

A fascinating assertion by Frank Field MP is reported in the Guardian. It is that many thousands of claimants are not medically examined as they should be. They are therefore given incapacity benefit when doctors think most of them should not receive the benefit.

Why are they not examined? It seems, if I understand correctly, that it is because there is a budget for the examinations and once that budget is used up, the administrators discourage General Practitioners from referring any more claimants for further medical examination. This sounds like monstrous incompetence and maladministration.

This is from the Guardian article:

Posted by James Bartholomew • Indexed in Waste in public services • Welfare benefits

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January 23, 2006
Monday
Somehow it is never pay or pensions that get cut for government employees

Not long ago, someone commented on this site that whenever all or part of the NHS runs out of money, wards are closed or operations are delayed or some other cost-saving measure is taken. But never are salaries cut back.

The fact illustrates the way in which government-provided services, as opposed to commercial or charitable ones, have a particularly strong tendency to look after their staff first, rather than the customers (or patients or students) who receive the service. Of course it does not feel like that to the doctors, nurses, administrators, teachers and so on. It feels to them like they are badly paid and enduring difficult and frustrating conditions. This is often true, too. But the fact remains that their pay and pensions are kept sacrosanct that would not apply if they were in the commercial or charitable world.

Further evidence of this came at the weekend in this story:


Posted by James Bartholomew • Indexed in Education • NHS • Pensions • Waste in public services

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January 16, 2006
Monday
The BBC makes progress and looks at benefit fraud

Another step forward: a six-part BBC series on benefits and how they got wrong. The first one, tonight, appears to be about benefit fraud. According the Telegraph,

David Street, the series' producer, said: "These are just a few of the cases that are prosecuted every year. The scale of fraud in disability living allowance claims is just staggering.

"I have made a lot of programmes about fraud and I have to say I was stunned by the size of this problem."

The full article is here.

The programme is on BBC1 at 8.30pm tonight and is called 'On the fiddle'.

Posted by James Bartholomew • Indexed in Behaviour & Crime • Media, including BBC bias • Parenting • Waste in public services • Welfare benefits

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November 26, 2005
Saturday
Yes, you are entitled to benefits but no, you can't have them

The inefficiency of state welfare is shocking and mostly unreported. As newspapers cut their staff ever more, they are all the more dependent on Government announcements. But now and again, in place of the propaganda, we get insights into what is really going on. This story tells directly of large-scale incompetence of the state in administering welfare. Such a thing would result in legal action and possibly bankruptcy for a commercial company or a mutual society such as the Equitable. What the story does not describe is the human distress caused to those at the receiving end. One can imagine people in genuine need and already in a bad way being thoroughly depressed by this maladministration:

Posted by James Bartholomew • Indexed in Waste in public services • Welfare benefits

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November 24, 2005
Thursday
Too many administrators compared to nurses

I was invited to appear on Radio 5 Live last night in a discussion about the decision of the NHS in East Suffolk that GPs and consultants will not refer anyone classed as obese for hip and knee replacements.

I argued that this level of rationing of healthcare was the inevitable result of having the NHS which, like most state monopolies, wastes its money and staff on an enormous scale. I referred to the study by Maurice Slevin which indicated that the managerial, administrative and support staff in the NHS per nurse runs at four times the level of a private hospital. In the NHS there are eight management, admin and support staff per ten nurses compared to only 1.8 in a private hospital.

Unfortunately I did not have the opportunity to counter an argument put forward by Roy Lilley (please excuse me if I have mispelled his name) a former NHS Trust chairman. He asserted that only 2.8 per cent of the staff in the NHS were senior management.

That is the sort of statistic that the NHS loves to trot out on such occasions. It gives the impression that there is no overmanning. But that impression is utterly misleading.

Posted by James Bartholomew • Indexed in NHS • Waste in public services

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November 09, 2005
Wednesday
Throwing bricks at British firemen - an echo of the French riots

The audience of parents of children at Tonbridge School last night was one of the most positive and supportive I have come across.

I talked mainly about how the welfare state has damaged the culture and morality of Britain and how it has led to higher levels of crime. One member of the audience responded by saying he had been a fireman who had worked in council estates. There had been youths there who he described as 'untouchables' - that is they were not touched or cowed by anything. They did not care if they were arrested, or got hurt or went to prison. These youths would throw bricks at himself and other firemen as they tried to put out fires.

Posted by James Bartholomew • Indexed in Behaviour & Crime • NHS • Waste in public services • Welfare benefits

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November 07, 2005
Monday
How the state wastes teachers' time and taxpayers' money.

It is often quite difficult to get at the convincing detail of how the state is a bad provider of services such as schooling and healthcare. Most people simply do not see the waste, inefficiency and organised morale-sapping in action and so do not believe they all exist. Here, though, is one example culled from the excellent 'Any questions?" column by John Clare in Saturday's Daily Telegraph.

The question asked is:

What is the "endless paperwork" teachers are always complaining about?

Posted by James Bartholomew • Indexed in Education • Waste in public services

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October 13, 2005
Thursday
NHS cutbacks

All sorts of cutbacks are currently taking place in NHS services. These are not announced, of course. Newspapers and the rest of us find out or just hear about them incidentally.

Yesterday an osteopath told me that because of a £30 million deficit in the accounts of the Kensington and Chelsea Primary Care Trust, osteopathy services had been cut. She said that the introduction of osteopathy had cut the waiting list for physiotherapy services from 20 weeks to 6 weeks. It had prevented many people developing chronic muskulo-skeletal problems. They had been caught in time. Now they would not be.

A few months ago a physiotherapist in Hampshire told me of cuts in physiotherapy there. She was in despair at what was happening. These are just straws in the wind to add to what is in the public domain. A survey by the BMA last month found 385 of the 530 primary care and other trusts had deficits totalling £2.4billion. St George's Healthcare Trust in London is losing 60 beds, trying to reduce a £24.5million overspend. It is truly remarkable that at a time when far more is being spent on the NHS that such cuts should be occurring. Even I - convinced as I am that there is huge waste in the NHS and that state monopolies have a strong tendency to be incompetent and wasteful of people and assets - must conclude that the maladministration is worse than I had imagined.

A relevant article in the Times is here.

Posted by James Bartholomew • Indexed in NHS • Waste in public services

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July 11, 2005
Monday
45 per cent of operating theatre time is wasted (and trying to get a cat to bark)

Sometimes it seems quite difficult to explain why the National Health Service fails to produce the quality service intended. There is a series of causes and effects. If you define just one cause and effect, you do not explain the whole thing. But here is just one part of the chain: the National Health Service wastes its own human and material resources on a vast scale.

This is a widely reported story in today's newspapers. This version is from BBC Online:

The Healthcare Commission found 45% of the theatre time in England allocated for day surgery was going to waste.

and further on,

The report, which examined 313 day surgery units in England, found one in 10 cancelled more than a third of the available operating theatre sessions and many patients had their operations cancelled at short notice.

In The Welfare State We're In, I looked at the story of how Capio, when it took over a hospital previously run by local government, significantly reduced the waste of time caused by cancelled operations.

Posted by James Bartholomew • Indexed in NHS • Waste in public services

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July 04, 2005
Monday
How Live8 may actually increase starvation in Africa

Moeletsi Mbeki, brother of Thabo Mbeki and deputy chairman of the South African Institute of International Affairs, wrote an open letter to Bob Geldof in the Mail on Sunday. It was all the more devastating for being politely expressed by a man who lives in and really knows Africa:

I know that you and Tony Blair have been genuinely touched by the suffering of Africa.
But, ironically, the contribution you are making is exacerbating the problem.

Posted by James Bartholomew • Indexed in Foreign aid • Media, including BBC bias • Waste in public services

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July 01, 2005
Friday
We told that the NHS just needed more money...

A friend took a child to St Thomas's with stomach pain earlier this week at about two o'clock in the morning. Although the girl was the only one in Accident and Emergency, it was two hours before she was told she had a bed in....Lewisham. She was then, in the early hours, transferred by ambulance to the Lewisham Hospital NHS Trust.

Posted by James Bartholomew • Indexed in NHS • Waste in public services

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June 25, 2005
Saturday
One part of Gordon Brown's incompetence

Gordon Brown's poor record as chancellor is gradually becoming more obvious.

This week, more light fell on his bad policy of tax credits. But first a quick summary of the bad policies he has pursued:

1. He has raised tax heavily to pay for investment in a monopolistic healthcare system (adding to the problem by fighting any attempt to make it less monopolistic). The result: the country will be poorer than it would have been and people less well cared for when ill.

2. He took a pension system which was amongst the most successful and well provided for in Europe and has put it in crisis. Result: more people will be poor in old age.

3. He has increased the prevalence of means testing - with all its disadvantages (see The Welfare State We're In and previous postings. One of the results: reduced savings (which will, again, cause more people to be poor in old age).

4. He has dramatically increased red tape, waste and errors through complicated systems - such as tax credits - instead of using much simpler methods (such as higher thresholds for tax-free income). By wasting public money, he has made us poorer. Through red tape he has cost us money again and wasted our time.

Here is some of the coverage of the problems Mr Brown created through tax credits:


Hundreds of thousands of families have suffered because of flaws in Gordon Brown's £13 billion system of tax credits, a watchdog says today.

Ann Abraham, the Parliamentary and Health Service Ombudsman, says poor families are particularly vulnerable because of the way they have been forced to pay back money given to them in error.


Posted by James Bartholomew • Indexed in Reform • Tax and growth • Waste in public services • Welfare benefits

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June 18, 2005
Saturday
A consultant gives an insight into why the NHS will not deliver, despite all the extra money

Rather strangely, neither the Telegraph nor the Guardian appear to have covered a story made a big impact in both the Mail and the Express this week. It is not a trivial, celebrity story but one that goes to the heart of one of the big issues of the time: whether the NHS model of healthcare can ever deliver a first class service.

A consultant surgeon, Mike Lavelle, has resigned from the NHS and leaked a letter in which he made a powerful attack on the way the NHS works.

"The delays in operating theatres are quite frankly scandalous" he says.

"I have no doubt that the service is grossly overmanaged now.. there has been an almost unbelievable increase in NHS employees who contribute nothing to the treatment of patients. But if you go onto my ward the nurses are struggling to look after the patients..."

Posted by James Bartholomew • Indexed in NHS • Waste in public services

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June 12, 2005
Sunday
The scandal of public servant pensions

Five million out of 5.7 million public sector employees (88 per cent) have final salary pensions. Meanwhile only 3.6 million out of 22.5 million private sector employees (about 16 per cent) have final salary pensions.

These figures, accourding to the Sunday Telegraph, will be published by the Government Actuary's Department on Thursday. There have been a fall of one million in those in the private sector who are on final salary schemes over the past five years. That is largely the effect of Gordon Brown's tax on dividends received by pension funds which has helped make final salary pension schemes just too expensive for private companies. But what is too expensive for private companies, is not too expensive for taxpayers to pay for.

The civil servant, the teacher and the hospital manager all get relatively luxurious, final salary pensions, courtesy of taxpayers. The MPs and the prime minister get the most luxurious pensions of all.

Posted by James Bartholomew • Indexed in Media, including BBC bias • Pensions • Waste in public services

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June 10, 2005
Friday
The 'special needs' fiasco

Baroness Warnock wrote a report over 25 years ago in which she called for children with 'special needs' to be included in mainstream schools. The 1981 Education Act incorporated her recommendations. Now she is apparently going to re-cant and say that the pressure to include pupils with special needs in mainstream schools causes "confusion of which children are the casualties". The following article appears in the Daily Express today alongside an article by Bob Black, saying he is pleased that his 17-year-old daughter Morwenna, who has Down's Syndrome, has been to a mainstream school:

Baroness Warnock's report started a movement which has led to some education authorities positively insisting that disabled children should go to mainstream schools. A policy started with the friendly, 'inclusive' ideas of the 1970s has gone badly wrong.

Posted by James Bartholomew • Indexed in Waste in public services

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June 09, 2005
Thursday
Governments are not good at running things

Earlier this week, the Conservative Party collected together some data about how the awesome way government has wasted money on computer projects:

...a new courts computer with an original budget of £146 million, rocketed to almost £400 million; a move of the GCHQ spy centre computers to a new building cost a staggering £450 million, instead of the projected £20 million; and a new national insurance payments system turned out at £90 millions over budget, after mistakes and problems had to be corrected.

More here.

Posted by James Bartholomew • Indexed in Waste in public services

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June 01, 2005
Wednesday
Governments don't make poverty history

When someone suggests that more money should be given to governments of third world countries to help them 'make poverty history' remember this article in Saturday's Daily Telegraph:

Five months after the tsunami struck, killing 40,000 and leaving 500,000 homeless in Sri Lanka, more than 100,000 of the poorest victims are still living in tents or crude temporary shelters.

Despite almost unlimited resources - the relief fund stands at more than £1.75 billion for Sri Lanka alone - victims are cooped up in camps waiting for news of progress that never seems to come.

Aid agencies keen to press on with rebuilding are being frustrated at every turn by the tangled and all-embracing bureaucracy of the central government. Shipping containers remain stuck at ports, vital building plans await approval and incompetent officials ignore the advice of specialists.

This week, as the first monsoon rains arrived, agencies were striving to move thousands of people out of their tents and into solid shelters before camp sites turned into quagmires.

After months during which the situation has deteriorated and no one has spoken out for fear of upsetting the highly sensitive government, the World Bank finally broke cover this week.


Posted by James Bartholomew • Indexed in Politics • Waste in public services

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May 27, 2005
Friday
What is the difference between government inspections and a waste of money?

The following comment on the government inspection of care homes seems worth putting up as a posting, too. I asked the author for a glossary of terms for those who are not familiar with all the organisations he refers to. They are at the end.

The government regulations are amazingly bad, cost a fortune to both care home owners and the public sector, and achieve nothing.

There are several problems.

(1) They are applied quite staggeringly inconsistently. Some hammer people for minor or invented infractions, some just ignore them. This tends to (IME) bias towards those run by the Public Sector. largely because the inspections are done by the former colleagues of the people in the public sector ; back scratching stuff.

It's a bit like Fire Regulations. With LEA schools the line has always been basically getting them up to scratch would cost an absolute fortune, so they are effectively exempted. Private Schools do not have this luxury. This seems to apply in NCSC/CSCI/CHAI as well.

(2) The Inspectors are laughably ignorant about the actual work, literally, I once had to leave the room because I had a fit of the giggles. It is tickbox mentality run riot. Because they have no clue, they focus on minutiae like how big the windows are, because they have no qualifications or experience to evaluate what is actually happening.

Posted by James Bartholomew • Indexed in Care for the elderly • Waste in public services

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May 25, 2005
Wednesday
Training nurses: 'a full day is 10 to 3'

The husband of a trainee nurse emailed me and mentioned that a third of the trainees drop out after only eight months. I asked why. This is his reply, which makes it appear that the training of nurses has gone beyond absurdity into a scandalous misdirected use of taxpayers' money:

They just appear to get fed up and wander off! There doesn't seem to be a "reason". The practice part of the job was hard work, but they were dropping well before that. One left four days after the start of the course.

To be honest, it's a complete skive as far as I can see. On Monday, she does about 90 minutes. Tuesday is a full day, Wednesday about half a day, Thursday is a "study day" e.g usually nothing, and Friday is a full day.

I reckon it is about 40% of "full time" study, most of which is lectures. A "full day" is more like 10:00 to 3:00 not what you are I would consider a full day. If they got on with it, they could probably do it in 2 years of full time courses.


Posted by James Bartholomew • Indexed in NHS • Waste in public services

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May 19, 2005
Thursday
The state finally realises that charities can do better but then spoils this breakthrough by forcing its own inefficiencies onto them

An email received today:

I've recently read your book and you raise a lot of good points. I teach in a college that retrains unemployed disabled adults and it is only too apparent that the welfare system has hindered as well as helped a large number of our students in the ways in which you describe. For many the financial incentive to work just isn't there, especially those with families, although often we are sucessful in changing peoples outlook and raising their aspirations.

Posted by James Bartholomew • Indexed in Education • NHS • Waste in public services • Welfare benefits

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Taxpayers' money wasted on excessive public sector pensions

More and more state spending is going towards paying the pensions of public sector workers.

This is from Patience Wheatcroft of the Times via the Civitas blog:

'In Greater Manchester, total pension payments for fire-fighters are put at £30.4 million in 2005-06, compared with salary costs of £74.9 million. This amounts to a doubling of pension payments in the past eight years... Council tax payers in the area have seen the amount that they pay for fire services rise by 68% over those eight years… [But] net of inflation and pensions, the Fire Authority’s budget has actually reduced by 7% over the period.’

There is nothing wrong, in principle, with money being spent on the pensions of public sector workers. The problem is with the practice. From the taxpayers' point of view, these pensions are unnecessarily and wastefully big, for two reasons:

Posted by James Bartholomew • Indexed in Pensions • Waste in public services

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May 11, 2005
Wednesday
NHS beds halve and crimes against the person up 281 per cent
The NHS is the world's third-largest employer with a million people on its books, second only to the Chinese Army and Indian railways. We spend some £80 billion a year on the NHS, equating to £1,400 annually for every man, woman and child. Despite this the number of NHS beds in England has halved in the past 25 years.
The average British woman will have 2.2 healthy pregnancies in her lifetime - almost enough to keep the UK population stable - but will give birth to only 1.7 children. The difference is accounted for by the number of abortions.
The number of people working in the public sector has increased by 10 per cent since 1998, accounting for some half a million of the new jobs created since Labour came to power.
Total public sector employment in 5.29 million, up from 4.71 million in 1997.
In 1981, 600,000 people claimed incapacity benefit. Now it is 2.2 million.
The greatest increases in recorded crime since 1997 have been in drug offences (509 per cent) and violence against the person (281 per cent) and there has been a drop in burglaries by nearly a fifth.
More than half the households in Britain have less than £1,500 in savings, and a quarter have no savings at all.
Teenage birth rates in Britain are twice as high as in Germany, and five times as high as in Holland.
150,000 children are educated at home, and the figure is rising. Bullying, harrassment and religion are the reasons most cited by parents for taking their children out of school.

From Britain in Numbers published by Politico's and serialised in today's Daily Mail.

Posted by James Bartholomew • Indexed in Behaviour & Crime • Education • General • NHS • Parenting • Waste in public services • Welfare benefits

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April 18, 2005
Monday
One of the ways the NHS wastes money

The star rating system for hospitals is being phased out. It has been a flop but that does not mean that money has stopped being spent on it. It also does not mean that money will cease to be wasted (often actually doing harm, in addition to the waste of money).

This from BBC Online:

"Star-ratings have had their day," said Michael Dixon, of NHS Alliance. "This year we will have star ratings without them being taking too seriously."

However the Healthcare Commission said the ratings were still relevant.

The last star-ratings will be published during the summer, but experts have said they will not be taken seriously because of the changes.

Star ratings, only introduced in 2001, have been overhauled after complaints they were too onerous and target-driven.

All 572 trusts faced three-yearly inspections, costing £150,000 a go.

Posted by James Bartholomew • Indexed in NHS • Waste in public services

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March 23, 2005
Wednesday
Words used by 'public servants' to obscure and self-aggrandise

From the latest Adam Smith Institute email newsletter:

My friend John Hughes, CE of Cygnet Health Care, has sent me a neat little squib mocking the tide of jargon in so many government services. It's basically just three columns, and you pick one word from each and string them together. He calculates it can generate up to 91,125 authoritative buzz phrases. Saves so much time writing reports to ministries. Here's a sample:

Proactive Performance Strategies
Collaborative Partnership Process
Developmental Community Potential
Resource-rich Governance Approaches
Interactive Organizational Pathways
Intensive Consumer-led Modifiers

So from that you can generate "proactive consumer-led approaches" or
"developmental community strategies" or pretty much anything you like. If only some of it actually delivered any service to the public!

The Adam Smith Institute website is here and the insitute's blog is here.

Posted by James Bartholomew • Indexed in General • General • Waste in public services

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