The NHS, Tesco and ten year old children.

Many years ago, more years ago than I care to remember, Wat Tyler (Burning our Money), James Bartholomew (The Welfare State We’re In) and Dr Crippen were at the same College at the same university. This was before blogging, before the internet, before even word processors. Dr Crippen used a typewriter and Snowpaque. Lots of Snowpaque.

It is a strange co-incidence – and it is a co-incidence, for there has been no discussion - that many years later there should be a meeting of minds when each of us considers ten years of mismanagement of the NHS, culminating in the recent MTAS debacle.

The NHS BLOG DOCTOR position has always been that:

A reasonable standard of health care should be available to all within a reasonable period of time without regard to income or status.

Nothing controversial there.

Day after day, all around me in the NHS, I see waste, complacency, mismanagement, financial profligacy and abuse. The controversy comes when I put forward my now unshakable belief that we must make a start by introducing a front end charge for health care, safety netted for those who genuinely cannot afford to pay. In simple terms there should be a “fee at the point of entry.”

Look again at the shortest and wisest post of the year on health care economics from “The Welfare State We’re In” - not from James Bartholomew himself, but from his ten year old daughter:

"When I was on holiday with mummy in Spain, when mummy was paying I didn't mind what I bought! But then she gave me 50 euros of my own to spend and then I didn't buy things in case, later on, I found something I liked better."

This is the short course in why capitalism works and socialism doesn't. It is a short course in why public services tend to be wasteful (ministers and the rest are spending other people's money).

When it is your own money, you don't waste it.

(From forth the mouth of babes)

Yesterday, we celebrated the demise of MTAS, but there is still much to be done. There are still thirty thousand careers to sort out. And then we must consider the cost of this debacle. Wat Tyler has begun his investigation. His starting figure is £6.3 million, but he will be travelling a long way north of that.

…having wasted so much time with MTAS, hospitals are staring down the barrel of a staffing crisis. As Professor Humphrey Hodgson, a liver specialist at the Royal Free Hospital, says: "We are in damage limitation in which we want to make sure that patient care does not fall between the cracks of this problem." …if you're planning to get ill, do it in the next couple of months.

Once again, the big lesson is that these top-down all-purpose masterplans just don't work. As with the Supercomputer, MTAS highlights the shocking lack of consultation with the people at the sharp end. Indeed, a spokesman for RemedyUK, the junior doctors action group, points out that ministers have still not included any of the junior doctors who have been affected by the problems on its review group.

No matter that the Commissars were responsible for the fiasco in the first place: they still apparently expect us to believe they're the only ones who can sort it out. When Hewitt gets fired this summer, the Department of Health will get its eleventh Secretary of State since 1985. In the same period, Tesco has had just two Chief Execs. Both of them joined the business straight from university and worked their way to the top. None of our last 10 Health Secretaries had any previous knowledge of healthcare, let alone how to run the world's third largest organisation.

Maybe the eleventh will be some hitherto unspotted healthcare management genius. But I don't advise holding your breath. (Wat Tyler: Burning our Money)

I suspect that both Wat Tyler and James Bartholomew would favour wholesale privatisation of the NHS. I would not go as far as that. We need to move away from the dogma of the left and the right wing. If patients had to pay for part of their care, abuse and waste would be dramatically reduced and, furthermore, patients would not put up with second rate service. They would insist on better treatment.

As the Wat Tyler film demonstrates, the NHS needs the management skills of a Leahy or a Maclaurin both of whom had thirty years or more experience of their organisation. We need to attract the best and to do that we need to pay an NHS chief executive a Tesco size salary and allow him autonomy to introduce proper business principles and efficiency into health care.