Conservatives created the NHS ‘bureaucracy’ they are now attacking

by Guest
February 25, 2011 at 11:13 am


contribution by Jon Taylor

The Tories talk a lot about how the public sector has become bloated, according to them, it has become ‘weighed down by bureaucracy’.

But is Tory policy not responsible, at least in part, for creating the bureaucratic system we see before us today? I think it’s about time the left started to challenge the notion that bureaucracy is solely a left-wing phenomenon. It’s not.

Ironically, in terms of the NHS, much of the bureaucracy at which Lansely directs his venom was borne out of the purchaser-provider split. A policy initiated by the Tories in 1990, and regrettably not reversed by Labour in 1997.

This move, for the first time, established the internal market in the NHS. The idea being that competition would drive up quality, productivity, and efficiency.

There is no evidence that this has happened. There is evidence, however, that the purchaser-provider split has led to a huge increase in transaction costs, notably management and administration costs.

Currently it is predominantly Primary Care Trusts (PCTs) that are responsible for commissioning or purchasing services on behalf of us: taxpayers and patients. Within PCTs sit many of these bureaucrats whom the Tories like to blame for the various failings of the NHS.

These ‘commissioners’ are responsible for purchasing services from another group of bureaucrats based in provider organisations; contract managers, accountants and a like. These people perform a critical function. They manage financial transactions.

It is hardly surprising; therefore, that, as the market has become embedded in the NHS, the number of people needed to manage transactions has shot up. The moment we introduced the market we began to need people to manage money flows, negotiate contracts, and administer financial transactions.

It is for this reason that the Tories ‘war on bureaucracy’ is disingenuous populism.

The Department of Health’s own unpublished figures indicate that transaction costs resulting from the purchaser-provider split account for 14% of total NHS costs. This is money that could be spent on frontline care.

Lansley knows very well the function performed by the bureaucrats he loves to pretend to hate. He also knows that opening up the NHS to ‘any willing provider’ will increase transaction costs and, as a direct consequence, increase in bureaucracy.

Although ‘officially’ they will no-longer be on the government pay roll, the tax payer will still be paying for them from the cash handed over to private firms by GP’s.

However, in 2013 the government will be able to declare a great victory. Lansley can claim to have defeated his great nemesis – bureaucracy. He can hold up the private sector as our saviour.

The private sector, according to him I’m sure, will have come to our rescue by re-employing and rehabilitating these lazy, good for nothing, parasitic, public sector pen pushers.

Therefore, rather ironically, Andrew Lansely will actually need to recruit more people to his rapidly expanding army of demoralised x-public sector bureaucrats in order to deliver his longstanding and well documented ambition: wholesale privatisation of the NHS.

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Jon Taylor works in the NHS for a Cancer Network, and is a trade unionist