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This is the transcript:
Somebody asked me an interesting question the other day.
They said, "What if Elon Musk offered the NHS £100 billion? Should we take it?"
I stress he hasn't done that. But let's just suppose for a moment that he did.
Most people would immediately say, "Yes, grab the money." After all, £100 billion for the NHS sounds like a dream solution. More money for hospitals, more doctors, shorter waiting lists: you'd be happy, right?
But here is the uncomfortable question that almost nobody asks. What if the problem isn't money at all? What if the real issue is something completely different?
Let's just suppose that Elon Musk really did transfer £100 billion to the UK NHS tomorrow. Would that automatically fix the NHS? No, it wouldn't, because money does not treat patients. Money does not perform operations. Money does not train doctors or nurses.
If the NHS does not have the staff, buildings, equipment, medicines, and the time needed to expand services, then that £100 billion would not deliver healthcare. It would simply bid up the price of the limited resources that already exist, and that is where inflation comes into all of this.
The key point is, inflation does not happen simply because money is created; inflation happens when spending exceeds the real resources available in the economy.
So the real constraint in the NHS is always the availability of doctors, nurses, clinics, and hospitals, medical equipment, medicines, and training capacity. If those resources exist, spending can mobilise them. If they do not exist, more money simply pushes up prices.
The constraint is always the real resources and their availability, and not the amount of cash that we have available to us.
That is why most debates about government spending often miss the point. People argue about where money comes from, but the real question isn't that; it's always, do we have the resources to use that spending productively?
If we do, spending, whether by the government or anybody else, including Elon Musk, could improve lives. If we don't, spending becomes inflationary.
So the real challenge for the NHS is not just funding. It is training, staff, building capacity and creating the resources that healthcare actually requires.
In that case, let me ask you, if someone really offered the NHS £100 billion tomorrow, would that fix the problem, or would the real issue still be the resources we have available?
Let me know in the comments what you think about this video, and please share this because we need to have this debate. The NHS needs more resources, and not just money.
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Yay! Thanks for this post. Thanks for highlighting something so often ignored.
Those of a neoliberal persuasion often say that “printing money” inevitably, and quite quickly, leads to inflation. This is untrue. It is, as you powerful describe, attempting to buy more than the available resources that causes inflation.
Another case in point is closing the Straight of Hormuz. Suddenly the supply of oil has reduced by 20%. Now people are trying to buy more oil than is available. The problem is not caused by too much money but by lack of a real resource. The result will be inflation even without printing money.
Another neoliberal trope is that it is only excessive government spending that causes inflation. What nonsense. It’s anyone’s spending that can cause inflation if the real resources aren’t available. In your example, spending by Mr Musk would cause inflation not government spending.
And this is another reason why inequality is so dangerous. It means that many people have a lot of money that they are not using and that they could spend at any time. If lots of them did so simultaneously, say due to some kind of adverse shock, then they could cause significant inflation. For this reason too much inequality leads to an unstable economy.
Surely the proverbial £100 million from Musk needs proper ‘project management’
As a Doctor once pointed out to me everyone has been to school and had contact with a Hospital/Medical Practice they think they know how it should be run. So I will
But yes there are all manner of resources that would need to be mobilised, not just bringing Sir Lancelot Spratt out of retirement but porters, would be Radar’s (MASH), engineers and builders.
They will need all manner of tools and materials not just beds and bandages but bricks and diggers.
Oh and how about trying to stop people getting sick in the first place?
I believe that the problem with the NHS is the complexity of the systems we now have. Money, pure and simple, without looking at process simplification will largely be wasted.
I need to say more about such a bald statement. I suggest that many of the NHS’s problems are thermodynamic in nature; they are due to those first two laws of thermodynamics which basically state (using everyday language) “You cannot get something for nothing” and the second law “Everything runs down”. You also need to consider the available “exergy”, the useful work that can be done by each pound spent. If 80p from every pound spent goes to meeting all the ‘overhead’ requirements, then you’re not going to see a lot of improvement in the services.
I suggest the NHS is now such a large, monolithic organisation that a thermodynamic analysis would show that simplification would really help. Responsibility should be given to staff at the lowest possible level for all that happens. Accountability is needed/essential, but it shouldn’t be excessively bureaucratic. The facilities and buildings in use need to be in good working order. In a local hospital I needed to visit recently, “OUT OF ORDER” signs were noticeable; going back a few days later and they were still there. Indicative of facilities that are run down that won’t be allowing the medical work to be maximised. I’m sure all who visit our hospitals know that the staff do their best, but that is modulated downwards in effectiveness by maintenance budgets having been raided.
We need to understand that the NHS has a monetary account but it also has a thermodynamic account that trumps the £s.
I have a friend who is a nurse in CAMHS. She tells me that there are many nurses seeking work whilst more cuts are being planned to services that are already on their knees. It’s a political choice that Labour, and the Tories before them, make, to deny these people employment and to deny the people of the UK the health service they deserve. In this case, the resources exist and there can be no adverse impact on inflation to put these resources to work. In fact, they’re guaranteed to pour money back into the government via Income Tax, NI and spending the bulk of their income on the essentials such as rent, food and utilities, unlike Elon Musk, who sits on his hoard like Smaug, petulant and vindictive, incapable of seeing his own greed and begrudging everyone and anyone who dares to covet even a fraction of a fraction of a percentage of the multiple numbers that make up his notional wealth. There isn’t a shortage of nurses, health care assistants or doctors – just a shortage of backbone and moral fibre in the detritus that passes for what sits on the green benches in Westminster these days.
The point you make is entirely valid but as you imply, the money could be used to employ staff who currently cant find work (GPs); train staff to fill the current 110,000 vacancies; increase staff numbers to expand services facing rising demand such as mental health (just had its budget cut once again); improve infrastructure (the NHS backlog maintenance bill in England – money required to bring estate up to standard – is now estimated at £16bn); build the promised 42 new hospitals and replace those at risk of collapsing from being constructed with reinforced autoclaved aerated concrete. We could even start training our own staff instead of poaching them from abroad (1 in 5 NHS and social care staff, 36% of doctors and 30% of nurses). The latter point is urgent since the hostile environment has led to a 93% fall in nurse applications from overseas. The cost saved on the training of migrant staff in their home countries before they come to prop up the NHS is estimated by the APPG on Global Health to be £14bn, dwarfing our foreign ‘aid’ budget. Musk, however, like Palantir’s founder Peter Thiel, most likely believes the NHS makes us sick and we are all suffering from Stockholm syndrome, so is not likely to want to get it back on its feet as a public service!.
I may have missed the point, but right now we have good doctors underemployed and looking for work (particularly GPs) due to lack of vacancies – despite the system being stretched beyond capacity. When NHS staff open up their NHS laptop each morning the first thing they are presented with is an advert for voluntary redundancy.
It does seem the need is greater than ever but the funding is not there (perhaps more correctly the willingness to fund).
I agree that a quick fix cash injection does not make a sustainably better health service. However, it’s not clear to me that the NHS is limited by lack of trained workers.
I like the new comment format, thank you!
The private sector has plenty of resources so we could charge very high rates of tax on those services in order to drive the companies out of business and free up the productive capacity.
I think one should keep a sense of perspective here
It is a novel way to frame the issue and based in reality.
We have become an ‘investment poor’ country. From what I see, most of what is called ‘investment’ is just a deposit to access revenues/rents from existing services or to create them by capital. The aim is to ‘extract’ not invest.
Real investment in jobs, skills and infrastructure is part of the holism that will solve problems in the the NHS. Instead, because we live in a lie of finite resources called ‘tax payers money’ we are told that investing in AI will miraculously solve the Thatcherite false consciousness problem by producing the same services more cheaply. Not only is this unfounded, but it is attractive to tax payers (until of course they experience it) and of course, it makes privatisation more likely as it will increase profits for vulture capitalists trying to get their noses in the healthcare trough.
The whole thing is a mess. The state will continue to ‘fail’, the private sector will ‘ride to the rescue’ and then what happened to the railways will happen to the NHS – I bet government expenditure will go up – because it will be feeding and rewarding capital first and providing a service last (doing that is not even second or third in these models).
Much to agree with
I had a conversation with a GP who had worked in different health systems and been involved in setting up a hospital in his home country. His opinion was that lack of resources within the NHS is less of a problem than poorly managed resources. I would have continued the conversation but had a health issue to resolve and my 15 minutes was almost up. But what he said raised the question: could the NHS make better use of the resources it does have? What would it take to do this? Prioritising the views of dedicated staff in various roles would be a good place to start.
I have already provided the obvious answer to this. The difficulty within the NHS is the false market structure set up by successive conservative and labour governments that needs to be abolished to create a single unitary healthcare system in an area. That would save massive cost and would allow the coordination of resources.