The NHS blame game


Government and Institutions
The British love affair with the NHS requires a certain amount of cognitive dissonance. On the one hand, it is widely cherished and perceived to be irreplaceable. On the other hand, we are regularly confronted with evidence of its shortcomings. It has never quite lived up to its reputation.

This could have led us to having, at best, a love-hate relationship with the NHS, but because the health service is ultimately run by the government, we have the convenient option of directing love towards the NHS and hate towards the government. When the NHS gets things right, it is because it is the envy of the world. When the NHS gets things wrong, it is the government’s fault for mismanaging and underfunding it.

The NHS spent £167 billion of our money in 2018 and we all depend on it to some extent, but the average person – myself included – knows almost nothing about the people who manage it. It is difficult to tell whether they are doing a good job and, while we regularly see examples of the service falling short, we can’t tell whether specific problems are due to under-funding, managerial incompetence or systemic failure.

And so we give the NHS the benefit of the doubt and blame the government. If a problem could have been solved by throwing money at it, we blame “chronic under-funding”, and if a problem could have been averted by making a different decision, we blame the Health Minister.

This week’s Panorama was a classic example. In recent weeks, many frontline NHS workers have been short of personal protective equipment (PPE), thereby putting them at unacceptable risk when treating COVID-19 patients. Leaving aside the fact that there is a global shortage of PPE and other countries are struggling with the same problem, the responsibility for managing stockpiles to cope with pandemics lies with the NHS and Public Health England. Neither of these organisations received any criticism from the Panorama team. The title of the programme was not “Has the NHS failed its workers?” but “Has the government failed the NHS?“.

One of the programme’s main allegations was that “the government” took COVID-19 off the list of High Consequence Infectious Diseases (HCID) in March 2020, thereby allowing “the government” to weaken the guidelines on PPE use. This, it suggested, was because “the government” had failed to buy enough PPE to go round.

But the decision to take COVID-19 off the HCID list was not made by politicians. It was made by Public Health England and their equivalents in the rest of the UK, with the Advisory Committee on Dangerous Pathogens in agreement. The guidelines on PPE use by health workers may have been “weakened”, but the guidelines are set by Public Health England, not politicians. And the procurement of face masks, gloves and gowns is not the personal responsibility of Boris Johnson or Matt Hancock, but of officials in the NHS and Public Health England.

Far be it for me to defend the government, but in the absence of any evidence that politicians actively discouraged stockpiling of PPE, it seems to me that at least some of the blame for the shortage should be laid at the door of the people working in procurement at multi-billion pound organisations who are specifically tasked with stockpiling it. But no, let’s just blame “the government”.

It might be comforting to believe that everything would be better if the NHS had more money and a different set of politicians was in charge, but wishful thinking will not prevent the same problems occurring in the future. It is a simple fact that our current set of politicians are going to be in office for the next few years. It is also a fact that the UK spends ten per cent of GDP on healthcare, more than the OECD average. Even before the spending splurge announced by Theresa May, the NHS was not underfunded by international standards and it makes little practical difference whether the Department of Health is nominally run by Matt Hancock, Jeremy Hunt or anyone else.

In a state-run system, the distribution of resources will often be dictated by political decisions. In the broadest sense, the buck stops with politicians. But organisations such as the NHS and Public Health England have a significant degree of autonomy and a vast layer of bureaucrats whose job it is to make decisions. The people at the top of these organisations, many of whom earn more than the prime minister, have power and therefore – as Spiderman fans know – responsibility.

Blaming “the government” for decisions taken at the micro level is not only questionable in itself, but can be unhelpful because it stops us learning the right lessons. It is like a football fan calling for the chairman to resign when the goalkeeper has a bad run of form. In one sense, the chairman is to blame – the buck ultimately stops with him – but the practical solution is to get the goalkeeper to improve, or replace the goalkeeper, or perhaps even bring in a new manager. A change at the top makes no difference unless the team is sorted out.


Head of Lifestyle Economics, IEA

Christopher Snowdon is the Head of Lifestyle Economics at the IEA. He is the author of The Art of Suppression, The Spirit Level Delusion and Velvet Glove; Iron Fist. His work focuses on pleasure, prohibition and dodgy statistics. He has authored a number of papers, including "Sock Puppets", "Euro Puppets", "The Proof of the Pudding", "The Crack Cocaine of Gambling" and "Free Market Solutions in Health".

17 thoughts on “The NHS blame game”

  1. Posted 30/04/2020 at 18:57 | Permalink

    An excellent article. I believe that Public Health England has 5,500 staff and one has to question what on earth they have been doing both during and before the crisis.

  2. Posted 30/04/2020 at 22:01 | Permalink

    Well said. Exactly what I’ve been saying all through this. How come the layers of NHS mgt and their quango overlords escape all responsibility and accountability? The buck seems to go straight from operational clinical staff to Whitehall, indeed cabinet. Well done for saying this. Now say it louder!

  3. Posted 01/05/2020 at 08:29 | Permalink

    Brilliant article. How the thousands of procurement managers and Public Health England have managed to escape any culpability is quite extraordinary – and shameful. Hopefully the NHS has learned some vital lessons from this pandemic.

  4. Posted 01/05/2020 at 11:09 | Permalink

    Wholeheartedly agree re your points on the NHS. The media are schizophrenic in their reporting! However, I do think successive govts have a case to answer with regards care homes, which were a disaster waiting to happen. Decades of underfunded social care and a chaotic national management structure meant the system was woefully unable to respond to this epidemic. The result is our elderly and infirm, those most at risk from this particular virus, have been left to die like flies. The irony is that most of them will have paid taxes all their lives and society (not just Govts) failed to repay them by ensuring they’re safety! We should all hand our heads in shame!

  5. Posted 01/05/2020 at 16:57 | Permalink

    Exactly what I think. I live in Colombia where there are a diversity of health insurers and a number of hospitals and an availability of doctors and nurses. If Emergency is swamped or I am parked in a corridor, we do not blame the government. Because there is no money tree. I am eternally grateful to the doctors for saving my life. Wherever you are, you do the best with the resources that you can rustle up

  6. Posted 02/05/2020 at 07:23 | Permalink

    Can you please send this to GMB, Piers Morgan, BBC and all the critics, who are depressing the nation with their continual and irrational comments on government inadequacy. Not one MSM have mentioned or investigated root cause, (China Lab or wet market). Shameful, a global pandemic’s o
    cannot be published due to the country of origin misleading the evidence.!

  7. Posted 02/05/2020 at 11:55 | Permalink

    Interesting 🤔 💁🏻‍♀️😗😂😳😍🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🥰

  8. Posted 02/05/2020 at 14:15 | Permalink

    Michael, I’m afraid that the excessive fatalities seen in UK care homes come back again to NHS arrogance and incompetence in decanting Covid infected patients into care homes.
    As a service economy, PHE and the NHS are not doing the country.any favours in selling British competence abroad.

  9. Posted 03/05/2020 at 13:23 | Permalink

    Totally agree about care homes. Maybe out of this tragedy may come some recognition that the funding and management of care has to given the same priority as NHS services generally, not the poor relation. I think the point about ‘blame’ is well made (although politicians have to share some responsibility) – the NHS Supply Chain exists to do this (supply) and when it fails, has to be held accountable as well. I am pretty sure that it is populated with some pretty well paid big hitters, totally absent from media coverage.

  10. Posted 03/05/2020 at 15:47 | Permalink

    The discipline of Public Health Medicine has much to answer for. It has long neglected it’s important core role of protecting the public from the threat of contagion preferring instead fashionable crusades against the chocolate chip cookie and alcopops. It was a unique branch of medicine in the 19th century in that it did more good than harm. In the 21st century it is unique again, this time for doing more harm than good.

  11. Posted 04/05/2020 at 12:00 | Permalink

    I completely agree with the direction of the article . It’s ridiculous to suggest recently appointed cabinet ministers and a PM are responsible for the purchase and stockpiling of routine medical equipment .
    The Govts role is to provide sufficient funding to allow the line management in the NHS to buy the necessary equipment in the quantity it needs . The previous Govt under Teresa May had recently increased NHS spending to record levels and PPE was amongst the cheapest and most readily available equipment at the time . The fact it was not purchased in sufficient volume shows:
    1. A lack of risk /contingency planning within the NHS for a possible event (such as a pandemic) that would require an increase in requirement .
    2. A failure of the NHS system of procurement to react in a timely fashion and obtain the necessary quickly.

    In any event the NHS has failed to protect its front line staff who have excelled in their dedication to their cause at this time despite the woeful backup of the organisation they represent .
    This entire fiasco should prompt a proper , objective review of the NHS , free from the usual political bias ,blame and hyperbole with the focus on providing a service of healthcare with supports front line staff in the execution of their roles in providing quality healthcare to the sick .
    The NHS is weirdly seen as some quasi national religion and is consequently beyond criticism despite the annual scandals that occur and are quickly buried . NHS whistle blowers are as we have recently seen,to continue to religious analogy , are already treated as “heretics “ and punished .
    Until the NHS is treated objectively and it’s performance assessed on the facts rather than the aspirations it will continue to fail when put under pressure .
    Sadly It will come as a major surprise to
    me if this objective review actually happens . The NHS has been so lauded in this crisis and the “blame” so effectively diverted , it would be hard for any Govt to hold it to objective account now .

  12. Posted 04/05/2020 at 17:47 | Permalink

    Well said. I totally agree with your argument. I am amazed and thoroughly disappointed that no-one has seen fit to challenge the largely invisible, yet well paid NHS management. In any other walk of life those charged with running an organisation would be taken to task if it fails to deliver.

  13. Posted 22/05/2020 at 20:04 | Permalink

    The press (including the BBC) would have no fun ripping into an unknown NHS quango boss. Will be interesting to see if there are some Chief Exec casualties of these opaque NHS organisations in the coming months – they have done their political master no favours at all – though I’m sure they will pop up leading other faceless NHS firms or DoH special functions.
    It’s also notable that although the key politicians seem to have been a bit bullish and naive in their media contacts – they have had the good sense not to try and throw these yet identified CEOs under the bus given the public’s lack on knowledge/media’s lack of recognition of the NHS fragmented hierarchy and confused accountabilities.

  14. Posted 23/05/2020 at 03:38 | Permalink

    Christopher Snowdon is a really bad writer. So he is saying we can’t blame the government for the actions of cost cutting business administrators (with little expertise in health) put in charge by the Tory government in the first place? Christopher Snowdon has done no real research for his article, and this amounts to no more than ill informed opinion. And I quote him, “but the average person – myself included – knows almost nothing about the people who manage it.” Well do some research !!…/organi…/public-health-england/about The PHE is a government appointed agency, and of course they have health experts advising under them, but business considerations are the priority here. Christopher Snowdon also says, “But organisations such as the NHS and Public Health England have a significant degree of autonomy and a vast layer of bureaucrats whose job it is to make decisions.” Christopher Snowdon, really has done no research, the NHS had far less expensive bureaucracy and far more autonomy before Thatcher got her claws into it.

  15. Posted 02/06/2020 at 15:15 | Permalink

    Yes, spending is average in terms of GDP, but the UK spends 50% less per capita than Germany (for example) on healthcare and the UK has far fewer critical care beds per person than many other OECD countries. In terms of outcomes, avoidable mortality in the UK is better than average for the OECD. For what it gets in terms of funding, it is quite efficient. Thoughts?

  16. Posted 03/06/2020 at 11:12 | Permalink

    One of the NHS problems is that so-called Independent Trusts are not Independent, as the Department of Health controls what happens and is subject to heavy interference by election watching MPs
    So , bad decisions are repeatedly made, but if an unsatisfactory outcome is evident, no one is accountable, especially the MPs!
    They bow to popular opinion, rather than looking at the total delivery of healthcare

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