Sunday morning differences of opinion on LBC. The link does not include all my counter-arguments on the NHS market and on nurses pay. The one on nurses may well be worth listening to the catch up on - he had not answer to that and his argument that money could not make the situation of nurses better was just nonsense.
Andrew Castle has, I suspect, never run a business, I have. His claim is wrong. Money can solve a great deal of problems in most organisations - and I gave him examples within the NHS on @lbc https://t.co/4T8kI5SVcd
— Richard Murphy (@RichardJMurphy) October 31, 2021
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Brilliant stuff Richard. The eternal mantra that public bodies, utilities and nationalised industries were and are intrinsically inefficient has always been supported by governments of all stripes under-funding them and under-resourcing them. This allows the dogmatic right to conclude that government “spending” is wasteful and private “investment” is good. Joe public is drip-fed stories in the overwhelmingly neo-liberal press about greedy public sector workers and fat-cat council bosses and NHS execs and it becomes common knowledge.
Castle is listed on Companies House data as a Director of a number of companies.
Examples:
MR AND MRS A. N. CASTLE LLP
TOUCHWAVE ON LINE
But why bring up business experience in a debate about the NHS which is not a business accountable to customers for its income: that does not mean one person in a debate is automatically wrong.
In this case you’re both right.
More spending *can* increase productivity
More spending on an organisation that hasn’t increased productivity when it has had more spending in the past, and consistently underperforms on international league tables compare to European universal systems – well that’s another issue – and that track record is the one that Castle was commenting on.
The OECD consistently ranks high on value for money
Well done Richard, you stood up to his bullying and constant interruption of you but you finally made your points and he was speechless as a result. He obviously had not a clue about the NHS organisation of local NHS commissioning groups and all the heavy burden of bureaucracy as a result. He did not know about the disastrous Conservative Andrew Lansley “reforms” in the early 2010s that threw the NHS into stress with the closure of essential services to make “savings” and demoralised the workforce (see Guardian 20/7/20).
Thanks
First of all, my admiration for going on there in the first place.
Castle did nothing to let you get you point across as some of the comments below on Twitter suggested.
What amazes me even today is that people just look at the over arching NHS budget cost and somehow think that the money is not the problem and it has enough – despite (since 2010) when we know that the Tories and Lib Dems effectively underfunded the NHS by – as I understand it – just keeping the budget as it was from that year. That was effectively a decrease in NHS expenditure year on year afterwards itself made worse by continued cost-cutting as seen in the PPE disaster when Covid came along.
What Castle is advocating of course is more management – the way in which New Labour played around with the NHS exacerbated that issue and then the infamous (as far as I’m concerned) Lansley NHS Bill made it much worse.
So what does Castle want then – more ‘internal market’ practice in the NHS to produce efficiency?
And efficiency for whom? Having empty wards and beds whilst waiting lists are long, and the management roster gets bigger and more expensive is not efficient for us patients I can tell you that!
There is a lot of misunderstanding about the NHS that detractors like the Tories make hay out of. My mother in law used to moan about waiting and spoke of lots of people being around seemingly doing nothing. It never occurred to her that these people might be trainees or it was a shift change/handover going on or specialists were doing the rounds, sitting around computers updating records.
When my late mother went into hospital in 2019, she was in a reception ward for two days that was obviously understaffed. Personally I can understand that scenario in a major disaster situation but mid week at an NHS hospital? Unacceptable – but it was palpable that the nurse who was on duty was harassed and under pressure. I wonder if she still works there?
One thing is for sure – the NHS is busy, and staffing has been cut. All under the Tory Government since 2010.
And they still get voted in.
You must understand just saying “spend more money” is counter productive. And to say there are no consequences is highly disingenuous. By your own admission eventually more spending leads to inflation and your only solution to higher inflation is higher taxes. So you cannot say spending and tax are not linked because they are. And eventually it is a question, albeit with a lag, “does the person in the street want to spend his own money or do they want the State to do it for them”.. and that is certainly how the argument will be presented.
No one here says just spend more money fir the sake of it
You are making up a straw man
Or you are simply wasting our time
Beth
Are responding to my post?
Now do come on.
I note that you’ve said nothing about the NHS budget reductions in real terms since 2010 – not mentioned either by Mr Castle?
What I should have said therefore was spending ‘the right amount of money’ on the NHS is what is required because that is not what the NHS has had from around 2010. That’s a fact.
NI contributions were originally designed as a ‘contribution’ in order to qualify to use the NHS – NIC was never meant to meet the full cost per individual – the underlying promise was for the State to pay for that cost in order that it made economic and strategic sense to have a healthy society for a healthy economy as well as healthy armies to protect it.
I don’t listen to LBC, but the quote suggests Mr Castle (should I have heard of him?) conflates two different things if he is talking about things not working well or not working efficiently.
If something is inefficient, then by definition it could be more efficient with the same budget. Nevertheless there may be a cost, possibly large, in moving from an inefficient to an efficient state.
If something is not working well, that can easily be a shortage of resources which is only solved by more funding. The NHS is an obvious example, although politicians miss the point when talking about efficiency for healthcare. One of the issues at the moment is that governments have removed any “inefficient” spare capacity – which is one of the reasons it doesn’t work well currently, it can’t employ that capacity to absorb peaks in demand or (as now) catch up on a backlog of cases. Successive ministers have demanded paring down of “inefficient” NHS management, which has resulted in problems on the administrative side of getting access to healthcare that affect the public as much as those resulting from a shortage of clinical staff. And the only sustainable solution to the staff shortage is to invest in training (and do so strategically at least a decade before a shortage is predicted to cause any impact) which requires spending money.
The comparison which really highlights the difference money makes is the one public sector where there is a proper market comparison. Conservative politicians complain perpetually about the inadequate quality of school education while often sending their own children to private schools. The average private school fee is £13,700 according to a recent report, while for state schools funding per pupil is £6,900 (and I suspect the median is considerably less since the average is boosted by the generous funding of London schools). Why are those politicians voting with their feet if they don’t think the extra money makes educational provision work better?
Good comment
Castle was British number 1 in tennis when that could be achieved by holding a racket
Oh that Andrew Castle – I certainly had heard of him but couldn’t imagine he would be part of a politico-economics debate. Does he claim any expertise, or is it just he’s become an all-purpose celebrity pundit?
Celebrity well to the right pundit