Money alone will not fix the NHS

Many years ago, during the huge surge in spending that the Blair government directed at the NHS, I came across an advert in the Guardian’s media section. It was for a very well paid secretary to work for the deputy press officer of a minor NHS Trust somewhere in Essex.

The idea that this Trust needed a deputy press officer, let alone that the deputy press officer needed a secretary, was ludicrous. It was to me the final proof that you can never improve a large organisation by just throwing money at it. The structure and systems will just absorb all of the cash.

That isn’t to say that the NHS didn’t need more money then – it did – nor that it doesn’t need far more now – it does. In 2010 the NHS was world-beating. Now it is crumbling. More money is good, but you also have to improve the way you spend it.

Which brings us to some good news: ever since the covid pandemic, the NHS has had a major productivity problem. More staff should mean more operations and treatments for more patients, but since covid that hasn’t been happening at a sufficient rate.

But now research by the IFS has found things are improving. Across many measures hospital activity is substantially higher in 2024, compared with 2023. NHS England has 3.6% more consultants and 6.4% more nurses and managed to deliver 10.3% more admissions and 9.2% more outpatient appointments.

That is a significant improvement and as the IFS says, “it is at least heading in the right direction”. There is, however, much more that needs to be done even to reverse the loss of productivity since covid, let alone improve matters further.

Labour has today announced that Health Trusts will be measured against each other by league tables, and that failing managers will be fired if they cannot turn things around. The health secretary Wes Streeting is promising a “no-holds-barred, sweeping review” of NHS performance.

Struggling trusts can expect to have “turnaround teams” parachuted in to take over the management, while top performers will have more freedom over spending.

This is all very good, but I do worry that it is always easy to blame the management, which is always treated like a burden on the NHS, sucking up money and wasting everyone’s time in useless meetings. If anything the NHS is under-managed.

Money has to be well spent and well managed. The government has spend considerable political capital in raising money to turn around the disastrous state of the NHS. Without better leadership and management, it will be for nothing.

This time let us hope there is no need for deputy press officers to have well paid secretaries. If you see jobs like that being advertised, you will know something is going wrong.