How to cut the NHS and the armed forces, without doing any harm

Bevan in 1948. No sign of a change facilitator

One more comment on the Fox situation. I made the point that Fox was an “OK” defence secretary. Actually, he may well have been better than that. Here’s an example of why:

“…in the bloated, top-heavy structure of our three armed services…. The scale of senior hierarchy graphically exposes the fallacy, so sedulously cultivated by the generals themselves, that our military is underfunded. The statistics of this bureaucracy are truly astounding.

Today, there are more generals in the Army than helicopters or operational tanks, while the Royal Navy has more admirals than ships and the RAF has three times as many senior officers as there are flying squadrons.

There are three times more senior officers than Apache attack helicopters which have played a vital role in Afghanistan. In the Army, we have only 10 deployable brigades, yet there are at least 170 brigadiers, 20 more than in 1997.

Similarly, we have just two armoured fighting divisions that could be put into the field (albeit with a great deal of notice,) yet the Army feels it necessary to employ no fewer than 37 major-generals. We have just a single army corps, yet enough lieutenant-generals to command 17 of them.

The absurdity of structure is made even more clear when it is compared to other armed forces. In America, for instance, the mighty U.S. Army has 302 generals compared to the British Army’s 255.

Furthermore the 210,000-strong U.S. Marine Corps, larger than all our three services combined, has just 84 general officers, eight times less than the number of generals in Britain.

The contrast with Israel, which has one of the world’s most formidable defence force, is striking. Though its armed services are roughly similar in size to Britain’s, 170,000 men and women, Israel has just one Lieutenant-General, 12 Major-Generals and 35 Brigadier-Generals.

This obsession with swelling the top ranks reflects a love of empire building, where chiefs tend to judge the strength of their authority by the number of senior staff they have under their command. But there are a number of serious consequences to this culture of hierarchical excess.

One obvious one is that there is less money available for the front-line troops, sailors and airmen. Another is that there are simply not enough operational jobs for senior officers, so they end up in a host of administrative and staff positions which could easily be filled by lower grades.”

…and there’s much more of this mind boggling profligacy, inevitably causing gross inefficiency in this superb and insightful article by Frank Ledwidge. To his great credit, Foxy had started to dismantle this nonsense, no wonder the top brass resented him. And the Brits helped liberate Libya at the same time. In a classically  sour article by Simon Tisdall in the Guardian, he claimed that the Libyan win was just lucky. Maybe, but how can he tell? The fact is that a slimmed down intervention, without using UK ground combat troops, still did the trick.

As with the army, so with the NHS. Even more so really, as Gordon didn’t stuff quite so may none-jobs into the forces as he did with the health service. Every day that The Knife goes to work this point is rammed home: change facilitators, change directors, the entire clinical governance department, the massively expanded public health set up, numerous “strategists” who lack any concept of healthcare etc etc etc. 60% of the NHS budget goes on pay, with all the ramifications of pensions, national insurance, outrageous amounts of sick leave, redundancy payments and so on. Cutting the payroll is where to save money.

Policy too, it’s actually a healthy sign that targets for elective procedures are not being met. These targets are arbitrary figures, driven by politicians in search of votes, not by patients. They represent a Soviet command economy style diktat, with no forward costings or understanding of competing demands, such as essential emergency care. They cost an absolute fortune, whether it’s putting more permanent staff on the payroll to meet short term objectives, or simply paying over the odds to the private sector, treatment centres etc.

Interestingly, as clinicians we are used to being told to make efficiency savings – without jeapordising patient care – of 2-5%, whatever the mood is that year. This is on the possibly reasonable basis that in a giant organisation with an enormous budget, inefficiency is inevitable, and such savings are  important checks and balances. Has it ever happened in the nonclinical side** of the service? If so, it’s gone under my radar.

This is more relevant than ever, in a week where poor nursing standards – which are a widespread fact – have hit the headlines in a big way. No hospital doctor will be surprised by this.

A colleague of mine, in vascular surgery, is prone to claiming that he could knock 20% off the local budget with no adverse effect on health. I have yet to meet a practising doctor who doesn’t agree.


**If you can stomach a taste of the freeloaders, bullshitters and general hangers on who have proliferated in the NHS in the last 15 years, try this advert for a mind-numbing conference, all on study leave funds, naturally. There are similar non-events every week


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