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That story can easily be told in reverse. NHS Logistics didn't run well. As is consistently true of government run organisations it was run so badly that most

That story can easily be told in reverse. NHS Logistics didn't run well. As is consistently true of government run organisations it was run so badly that most of the NHS didn't even try to use its services. At the time of the privatisation the NHS sourced around half a million products but only acquired 50,000 of them via NHS Logistics. The entire purpose of privatising it was to try and make it work better and thus to encourage the NHS to buy more centrally to get bulk discounts, something that wasn't going to happen for as long as doing so required them to work with a small, sclerotic socialised bureaucracy. Why would anyone think that an organisation which had no economies of scale, nor any demonstrated expertise in logistics in a competitive environment, be better at delivering things than DHL, a world famous delivery and logistics company that the NHS frequently chose to use anyway in preference to its own operation? That's ideology. How much did NHS Logistics workers care about the health of the citizens who paid their salaries? Not at all: even though many of them were going to keep their jobs anyway they reacted to privatisation by going on strike and picketing trucks to stop them delivering supplies to hospitals. That's ideology. Fortunately it didn't kill anyone, but only because hospitals were already mostly bypassing the striking workers already due to aforementioned poor performance. The NHS had its limits thrown into sharp focus this year. Mass testing is a bad idea, but putting that to one side for a moment, Germany and indeed most other places were able to ramp up test volumes far faster than the UK did, because Germany used private labs from the start when the NHS insisted on only using NHS labs, despite being given direct commands to scale up testing as fast as possible. That's ideology. Finally, the supply chain hasn't been effectively renationalised. The contract changed from DHL to Unipart: https://spendmatters.com/uk/dhl-challenges-loss-of-nhs-logistics-contract-is-unipart-capable/ https://spendmatters.com/uk/dhl-challenges-loss-of-nhs-logis... Supply Chain Coordination Ltd is what the name suggests: a relatively small coordinating body that manages contracts for various services, including contracts for logistics provisioning. The brutal reality about the NHS is that not a single country in the world has copied this model. If it was good we'd see other countries adopt it but they don't. They don't adopt it because it's not good: this model is a relic of a time when the British public had just won a world war and as such had been exposed to years of war propaganda that made the government look artificially competent. In countries where that didn't happen the idea you'd want a single, centralised government agency to run every aspect of something as vital as healthcare was seen as insane: after all, if you go down that route why not have the government supply all food too? All entertainment? Why not run a fully USSR-style economy? Well because we know it doesn't work, that's why. There's nothing magical about the NHS that renders all those experiences irrelevant.

colinb 6y ago
Your last paragraph caught my interest. Can you point me at countries that are widely accepted to have done a better job? My own experience of the NHS (as a non-Brit who lived in the UK for more than a decade) is that it is inefficient at the small things (sitting in a waiting room for an hour - but being shamed if I show up 10 minutes late for my appointment) but brutally effective at big important things (treatment for life threatening diseases - worked well, but the biscuits were rubbish). I know this isn't data, but I also know that British people love to carp about the NHS, and having lived with health services in two other industrialised countries, I quite liked it.
- thu2111 6y ago
  The problem with British people's opinions of the NHS is that they routinely conflate the NHS with healthcare. (BTW, I am British myself). You're doing the same thing here. The NHS is not healthcare. The NHS is not doctors or nurses or life saving operations. The NHS is not hospitals. All first world countries have these things, but none have an NHS except Britain. The NHS is a bureaucracy that manages resource allocation. That's it. That's all it boils down to. When you saw life saving operations working as hoped, that isn't happening because of the NHS. You'd see the same in France, Germany, Sweden, the USA, Japan or many other places. We don't judge the skill of a bureaucracy or institution based on the skill of individual employees, we judge it based on factors like: 1. How much overhead does it impose? 2. How competent is it at organising its operations? 3. How agile is it, how able is it to react to new circumstances and continually improve itself? 4. How many people can access its services, who might want to use them? 5. If it fails at any of those criteria, how easy is it to switch to a competitor? The NHS varies from average to poor when evaluated by these criteria, with the exception of (4) where it gets the best possible score because it even happily treats people who flew in to the UK specifically for free treatment! But if we exclude that edge case then it becomes pretty average again, because universal access is solved in other societies using insurance schemes of various kinds (sometimes mandatory and subsidised). The exception is the USA where for cultural reasons a lot of people don't like being forced to buy health insurance. Although its overhead is reasonable when evaluated in pure GDP terms, this is achieved partly through building up large maintenance backlogs which is hardly sustainable: true cost of the NHS to the UK should probably be higher than is actually reported. The government has tried several times to force the NHS to spend money on maintenance and upgrades but usually fails: the NHS takes whatever money was granted to it for this purpose and immediately spends it on daily operations in violation of their agreements. Nothing happens because to Brits the NHS is a holy religion, so NHS management don't really feel accountable. The biggest problem with government run industries is not that they can't carry out their mission at all. Soviet factories successfully made steel and rockets, after all. Their problem is lack of agility and lack of quality. Agility: see the NHS testing ramp-up problems discussed in sibling threads. Quality: see how slowly the NHS ramped treatment back up after the April shutdown. Other countries did much better in that regard, because private hospitals desperately want to treat people in ways that the NHS just doesn't. How could it be otherwise: if private hospitals don't treat people then they run out of money and go bust, like any other business. If the NHS doesn't treat people, its staff basically get a paid holiday with no negative consequences. Of course that affects people's behaviour. I said average to poor, that's true except for (5) where the impact is catastrophic. Its tax funded status means the private health sector is seriously throttled in the UK. So only the rich can work around NHS failures, and even then not always (private hospitals don't do the full range of treatments in the UK).

colinb 6y ago

Your last paragraph caught my interest. Can you point me at countries that are widely accepted to have done a better job? My own experience of the NHS (as a non-Brit who lived in the UK for more than a decade) is that it is inefficient at the small things (sitting in a waiting room for an hour - but being shamed if I show up 10 minutes late for my appointment) but brutally effective at big important things (treatment for life threatening diseases - worked well, but the biscuits were rubbish). I know this isn't data, but I also know that British people love to carp about the NHS, and having lived with health services in two other industrialised countries, I quite liked it.

thu2111 6y ago
The problem with British people's opinions of the NHS is that they routinely conflate the NHS with healthcare. (BTW, I am British myself). You're doing the same thing here. The NHS is not healthcare. The NHS is not doctors or nurses or life saving operations. The NHS is not hospitals. All first world countries have these things, but none have an NHS except Britain. The NHS is a bureaucracy that manages resource allocation. That's it. That's all it boils down to. When you saw life saving operations working as hoped, that isn't happening because of the NHS. You'd see the same in France, Germany, Sweden, the USA, Japan or many other places. We don't judge the skill of a bureaucracy or institution based on the skill of individual employees, we judge it based on factors like: 1. How much overhead does it impose? 2. How competent is it at organising its operations? 3. How agile is it, how able is it to react to new circumstances and continually improve itself? 4. How many people can access its services, who might want to use them? 5. If it fails at any of those criteria, how easy is it to switch to a competitor? The NHS varies from average to poor when evaluated by these criteria, with the exception of (4) where it gets the best possible score because it even happily treats people who flew in to the UK specifically for free treatment! But if we exclude that edge case then it becomes pretty average again, because universal access is solved in other societies using insurance schemes of various kinds (sometimes mandatory and subsidised). The exception is the USA where for cultural reasons a lot of people don't like being forced to buy health insurance. Although its overhead is reasonable when evaluated in pure GDP terms, this is achieved partly through building up large maintenance backlogs which is hardly sustainable: true cost of the NHS to the UK should probably be higher than is actually reported. The government has tried several times to force the NHS to spend money on maintenance and upgrades but usually fails: the NHS takes whatever money was granted to it for this purpose and immediately spends it on daily operations in violation of their agreements. Nothing happens because to Brits the NHS is a holy religion, so NHS management don't really feel accountable. The biggest problem with government run industries is not that they can't carry out their mission at all. Soviet factories successfully made steel and rockets, after all. Their problem is lack of agility and lack of quality. Agility: see the NHS testing ramp-up problems discussed in sibling threads. Quality: see how slowly the NHS ramped treatment back up after the April shutdown. Other countries did much better in that regard, because private hospitals desperately want to treat people in ways that the NHS just doesn't. How could it be otherwise: if private hospitals don't treat people then they run out of money and go bust, like any other business. If the NHS doesn't treat people, its staff basically get a paid holiday with no negative consequences. Of course that affects people's behaviour. I said average to poor, that's true except for (5) where the impact is catastrophic. Its tax funded status means the private health sector is seriously throttled in the UK. So only the rich can work around NHS failures, and even then not always (private hospitals don't do the full range of treatments in the UK).