When More Equals Less in the British NHS

The Times (UK) and other UK papers have reported on continuing deficits afflicting the UK National Health Service (NHS). For example, this Times report noted how London hospitals are delaying elective services for as much time as is allowed by national targets (e.g., outpatient appointments, 13 weeks, elective surgery, 6 months). Furthermore, "other NHS trusts are saving money by removing patients from waiting lists, a policy condemned yesterday by doctors." "Dr Paul Miller, chairman of the British Medical Association's consultants committee, said this practice was 'outrageous.'"

A Times editorial wondered why these deficits were happening, given that "NHS spending has increased by 20 billion [pounds sterling] since 2000, a 40 per cent rise." Particularly,

Money that voters expected to go to the sharp end has instead been spent on administration. Since 1998, the number of NHS managers in England has risen three times as fast as the number of clinical staff, doctors and nurses. At the same time, despite the injection of billions, NHS productivity has fallen 1 per cent a year since 1997, which itself is an indictment of those managers.

The rising numbers and costs of health care managers, accompanied by rising costs of health care, but not necessarily better access or quality, seems to be a frequent, if not global pheonomenon. (See our previous post about the rapidly rising numbers of US managers here.)

Again, part of the problem is that work in a bureaucracy tends to grow to occupy all the bureaucrats. A bigger part of the problem, as we just noted, is that many of these managers don't seem to understand the health care context, or share the values of health care professionals.