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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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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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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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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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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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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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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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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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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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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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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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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"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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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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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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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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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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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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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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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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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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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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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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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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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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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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