This is a headline story in the Guardian this morning:
Hospitals in England could axe more than 100,000 jobs as a result of the huge reorganisation and brutal cost-cutting ordered by Wes Streeting and the NHS's new boss.
The scale of looming job losses is so large that NHS leaders have urged the Treasury to cover the costs involved, which they say could top £2bn, because they do not have the money.
This demand from Wes Streeting is absurd. The NHS is already one of the most efficient health services in the world in terms of admin costs.
There is clear evidence that in previous rounds of cuts that supposedly cut admin costs, doctors had to take on the administrative tasks instead, resulting in serious losses of medical productivity. This finding has been replicated right across many public services and organisations, not least from my own experience in universities.
And yet, Streeting is determined to sack 100,000 people at a cost of £2 billion to:
- Harm NHS efficiency
- Make doctors do admin, and not treat patients
- Increase patient waiting times as a result
- Reduce NHS productivity
- Increase unemployment
- Reduce growth
- Cut government tax revenues
- Make it harder for Rachel Reeves to balance the books.
It is, then, a policy right up Labour's street. It is a bad idea that is bound to produce the exact opposite outcomes to those they claim, which is pretty much true of everything that they seem to want to do.
I do sometimes wonder what it would be like to live in a country where:
- Politicians had real-world experience
- Politicians could think
- Politicians could join up the dots in the economy
Is it really crazy to imagine that might be possible?
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He couldn’t be trying to do what Thatcher wanted to do with ‘Working for Patients’?
Make the NHS such a mess and then turn around and say that the private sector are the only people who could sort it out?
Just a thouight.
Yes, of course
I’d like to think your question was ironic! Anyone paying any attention at all has easily been able to see that this process – undertaken by the single transferable neoliberal party of government – has been going on for decades.
“I do sometimes wonder what it would be like to live in a country where:
Politicians had real-world experience
Politicians could think
Politicians could join up the dots in the economy
Is it really crazy to imagine that might be possible?”
You are describing China, right now.
Hmmm while I don’t disagree with your desires, having lived in China I don’t buy into how many discontented Westerners exalt that country.
First of all many of the videos you see praising particular aspects of Chinese life really only pertain to a few big cities. Big cities which are every bit as atomised and impersonal as in the West.
Second of all, it *is* a totalitarian one party state. People can criticise certain policies but the political structure is off limits for debate.
Thirdly it is a deeply racist country with a nasty under-current of ethnic supremacy vis a vis internal minorities and external foreigners. What the Western media says about the Uyghurs and Tibetans is true. I’ve seen it with my own eyes – I taught Uyghur girls who’d been separated from their families aged just 12 and sent to Han boarding schools on the other side of the country for 10 months a year. I’ve heard Han colleagues say they only fail minority students.
Fourthly, agreements and contracts are meaningless there because selfishness is rampant.
Fifthly, there is almost zero social support in time of unemployment, sickness and disability. They just manage to hide all the homelessness and social problems that this causes.
Sixth, they practice historical amnesia whereby China has never done anything wrong and foreigners are only ever to blame. Despite sending vast amounts of aid during WW2 and even having commandos operate behind Japanese lines in Yunnan province, Britain features highly in this schema.
Yes, the trains are good (they copied them from Japan) and they’ve made huge technological progress, I would never go back there and I am telling anyone who will listen, their economic problems are far bigger than they are admitting to because they have created a vast property and loans bubble – up to $14 trillion in potential losses in their rural banking sector alone.
So no, China is not the future.
Because of your post I looked up Michael Hudson who often writes warmly of China. I find a lot of interesting and useful points in his work. In this link we have bancor, MMT and its reception when trying to publish articles, public debt, tariffs in the US in the early 20th century, the role of central banks and China’s advantages.
https://michael-hudson.com/2025/04/how-private-banking-replaced-public-money/
However, I feel a growing sense of caution when reading some of his work. The BRICS may well offer a new and a better way forward but the extent of America’s failings should not obscure the BRICS shortcomings and challenges. Your points about China rather reinforce of my less informed misgivings..
No one has a perfect model
If I could respond point by point
No country is perfect, China is still developing, but it is doing it much quicker than most.
George Washington was an advocate for a non party state as parties “distract” the work of government.
I will be blunt here, What Western media says is actually false, and based on nonsense from Adrian Zenz. When Zenz tried to defend his nonsense in a debate at a US college he lost resoundingly. As for your personal experience, I would only say that maybe you saw what you wanted to see, and claims of “deeply racist country” are not backed up elsewhere
I have dealt with China for the last 30 years with no problems. I have been ripped off by Uk businesses but I would not generalise.
China has unemployment assistance, pensions insurance etc, same as other countries along with Dibao which helps with those in dire need
China has been involved in fewer conflicts than NATO countries.
I would also add that China’s civilisation predates western civilisation by many centuries and it has led to a more egalitarian idea of what society should be.China is not exceptional, nor would they claim to be, but I suspect they are closer to being the future than many “developed” countries
Can I ask for more respect please?
Disagreement is fine. Please avoid direct accusations.
@Sean
“China is still developing, but it is doing it much quicker than most”
They’ve had two centuries to observe what others have done and they’ve still managed to create a far bigger financial crisis than the West did in 2008. There are 50 million Chinese living overseas and barely 300,000 foreigners in China. People vote with their feet.
“What Western media says is actually false”
Not regarding the Uyghurs and Tibetans it isn’t. Those territories are colonies which were conquered by the Manchu and then reconquered by the Communists. Taiwan is also a former colony which has broken away – it’s like Australia, it has an indigenous population which has been made into a minority against its will by Han Chinese settlement.
“you saw what you wanted to see, and claims of “deeply racist country” are not backed up elsewhere”
I’d been studying classical Chinese culture from the age of 16 when I went to live there aged 37. I went there with a completely open mind and initially enjoyed myself. But as time went on I began to observe the selfishness, the xenophobia and the inferiority-superiority complex, and I was messed around something chronic about money and agreements. I remain a huge fan of arts like Tai Chi, Qi Qong and I use Chinese medicine. But the social culture is not for me.
There have been several racist attacks including murders and there are no limits to what is said online
https://table.media/en/china/feature/xenophobia-what-the-latest-attacks-on-foreigners-in-china-tell-us/
https://www.nytimes.com/2024/07/04/business/china-hate-speech-xenophobia.html
https://link.springer.com/article/10.1007/s12140-023-09416-6
The last one I experienced personally. I was teaching Chinese students online during COVID and they felt enormous glee that we were all locked in our houses when they weren’t. There is a really nasty culture of schadenfreude there.
“China has unemployment assistance”
And it pays a pittance. The CPC is opposed to the Western model of the welfare state because they have much in common with the neoliberals:
https://www.cato.org/blog/xi-isnt-follower-hayek-he-should-be
https://www.hudson.org/economics/how-weakness-social-safety-net-undermines-political-compact-china-thomas-duesterberg-alexander-aibel
“China has been involved in fewer conflicts than NATO countries”
Good. But it is of course building up a huge army with which it plans to dominate Asia. How did China get to be so big in the first place?
“I would also add that China’s civilisation predates western civilisation by many centuries”
Who cares? If that had done them any good, they wouldn’t have had all the various tragedies that they’ve had. The “5000 years” narrative is a cope to make themselves feel better.
“and it has led to a more egalitarian idea of what society should be”
They really are not egalitarian in their outlook. It’s actually a very status orientated society internally and in terms of how it relates to foreigners. I stopped having any sympathy for their “century of humiliation” neurosis once I saw how they spoke about countries like Vietnam who they’ve bullied for centuries.
“China is not exceptional, nor would they claim to be”
They really do. The name of the country – Zhongguo literally means “Middle Kingdom” – the central state around which all others revolve.
“but I suspect they are closer to being the future than many “developed” countries”
I bet you they aren’t. And there’s no need to put the word developed in quotes.
I reiterate my request for calm here.
@ Richard
No problem, sir.
“Politicians had real-world experience”
on a trolley for 10 hrs waiting for treatment?
Obvs, it won’t happen to “Silly boy” Streeting, but I live in hope.
There is an argument for all politicos being treated on the NHS & always being @ the back of the queue – always.
Yes, but AI can step in and streamline all the processes, making the NHS even more efficient! Remember, AI can’t do your job, but the people selling AI can convince your boss to fire you and replace you with AI. That is it’s true power.
True
And then we’re in an even bigger mess
They clearly dream of making the NHS like McDonalds where you order your food on a screen.
Impersonal and anti human.
Brilliant!
Could we add ethics driven and evidence based? Rarely is either of these.
Efficiency is usually counter to evidence base, inequality causes poor mental and physical health, it’s causal not correlational.
You don’t need growth growth growth to solve inequality.
It’s primary level maths, how do you make these two groups of 9 and 4 more equal?
One of the biggest healing effects is being able to see your trusted doctor, who knows you and your body well. Duly ignored by efficiency.
Agree much wasted time doing other people’s jobs, admin support is skilled work, and lots of frontline workers aren’t trained or aren’t good at it, the demands of their real job are too reactive.
I produced an intervention for public service relevant to hundreds of a high need group , we have no support services so was asked to do work on graphics, which was formerly skilled business support. I haven’t got a clue how to do this and it will take me hours, and will probably still be rubbish.
Don’t know how many hours senior prac and frontline workers spend staring into their computer screens, but I would imagine this has increased in last 20!years, and this activity- staring into a screen- I would imagine, has a weak correlation with positive health and well being outcomes in healing professions.
The evidence base is clear – people change people.
But UK despite Bowlby being British, is a covertly anti attachment society,
Neoliberalism is an attachment denying creed, despite there being decades of research and evidence for attachment as fundamental to human functioning and thriving and no evidence for neoliberalism, the dominant lens is neoliberalism and attachment is blind sided.
So called Efficiency is just another deceit from the Neoliberal-lie-factory.
Perhaps needs to be accurately named to be tamed.
Privatisation efficiencies is a suggestion
Thank you and well said, Richard.
That may have to do with, as per Jolyon Maugham this morning, Streeting’s donors and a recent transaction for the benefit of someone close to Streeting.
Noted
“This finding has been relocated …” – is that meant to be “replicated”?
Yes
Changed
Thanks
Streeting is the epitome of our political system – utterly, openly and brazenly corrupt – .
‘Donors’ bribing or promoting a factional take over of a political party doesn’t prompt any curiosity from ‘public service’ broadcasters.
And it takes pitifully small sums for politicians to sell their souls – presumably in the expectation of riches to come’ once they have dismantled the NHS, fragmenting democracy through quasi self governing freeports, Enterprise zones
Already a vassal state, – roll on Blackrock, United Healthcare, Heritage Foundation, Palantir, and the controlling global oligarchs….
OK its a sitcom but it was Radar & later Klinger, the Company Clerks who made the 4077 MASH work whatever happened.
https://en.wikipedia.org/wiki/M*A*S*H_(TV_series)
Indeed….
They know very well what they’re doing. We live in times of deception where what they say they’re trying to do and what they’re actually aiming at are completely different
They absolutely do make sense. You create large gaps in the NHS service by removing staff and services and then award contracts to the private companies who sponsored you to fill them. It’s not that difficult to see – for me anyway.
This happened with the police in 2010-2015. Already having lots of paperwork, the redundancies of 21,000 officers and 18,000 backroom staff didn’t just remove bodies, it removed decades of expertise and enabled the gutting of intelligence sifting, internal monitoring of coppers and jnternal investigations. In some forces, recruitment was outsourced. We now have copper murderers and rapists, half the forces using racially biased AI profiling, and the Met still the corrupt political tool it always was.
Not just my view but my sibling ex coppers.
This is where the Mays and Streetings take us.
I could write a book with details of the hours of time and forests of correspondence generated by administrative (not clinical) failures in the NHS. I, my late son, and my wife have had a lot of long term dealings with NHS since 1950s to present day, through many central government re-organisations.
I shudder to think what Wes Streeting’s donors have up their sleeves with his hare-brained 10,000 redundancies.
Our current cockups mainly centre round trying to work out what happens to correspondence between our GP and whatever private provider our care has been contracted out to. We take the initiative in trying to make sure correspondence gets through by copying, emailing, phoning and scanning to produce hard copy to physically hand over, but still after 4 years, unless we intervene, letters, scan & blood test results cannot get from publicly owned NHS computers to private providers contracted to supply NHS surgery.
I’m wondering whether to get them interested in carrier pigeons, after all, it worked in the war.
Meanwhile, do I send the bill to Wes? He could pay me out of his humongous private healthcare provider political bungs.
Correction – for 10,000 redundancies read 100,000.
Sorry.
(Agile health care – road to recovery – terrible inheritance – difficult decisions – cast-iron donor rules – hardworking whatisnames – growth-led something or other – limited resources – public purse – small boats – ambitious targets – historic levels of hoojumaflips etc.)
“Thank-you Minister.”
Might the governance of this country be more transparent, more symbiotic/less parasitical and pseudo- democratic if the main stream media used critical thinking and exploring when dealing with the single transferable party?
Might it be that the recent and current relationship between the single transferable party/“deep government” and the main stream media is that of a cartel?
P. S. Who might gain from our mass education set up so avoiding the teaching of critical thinking and questioning?
In ideas terms they are a cartel
I have only recently discovered your blog and to quote you I find “much to agree with”.
In your bullet points detailing the consequences of Streeting’s plan, you state:
– Make it harder for Rachel Reeves to balance the books.
My understanding of your position (and I agree) is that “balancing the books” is not a useful way to describe government finances and so I question its inclusion here.
A very minor point really – I do understand the intent of what you write but my need for things to be unambiguous was triggered 🙂
I think you might well find the search function on the blog useful – but remember this is a Boolean search engine – so phrases often need to search in inverted commas.
Ben Z-B,
I think that bullet point is Richard being ironic, and is related to his wish for “Politicians [who] could join up the dots in the economy.” In other words, Wes Streeting’s cost-cutting plans for the NHS are going to affect the economy in ways that are not helpful to Rachel Reeves and her precious fiscal rules, yet no-one in the government seems to grasp this.
Correct
Or at least they make no sense unless you reflect that the purpose of the redundancies is to weaken the NHS to facilitate privatisation and to allow the future funding that would have been required to retain those posts to be applied instead to ensuring the future profitability of private healthcare corporations and to support the removal of the cap on private care funding.
Then they make sense, albeit that they will be greatly to the detriment of patient care and national health.