It’s Prime Minister’s Question Time and the Leader of the Opposition Harriet Harman asks David Cameron: “Can the Prime Minister confirm that the government will continue to guarantee that no customer of Tesco will have to queue at the checkout till for longer than 10 minutes?”
Mr Cameron responds that government policy is to ensure that British shoppers will always have ready access to sufficient and nutritious food supplies at the lowest possible cost but he doesn’t specifically answer Ms Harman’s question. She leaps to her feet again, repeats the question and demands a simple “yes or no” to her question. Again, Mr Cameron responds with the government’s overall objectives in its food supply policy but avoids a direct answer to Ms Harman’s question.
For the rest of the day, the country’s news media are dominated with the question of whether Tesco’s customers will soon find themselves queuing for more than 10 minutes at the tills. The nation goes to bed with Jeremy Paxman’s final pronouncement that the government clearly has no policy on Tesco checkout lines.
Absurd? Well, apparently not when the institution is the NHS and the subject is waiting times to see a cancer specialist. Yet that is the inevitable result with a bloated, highly politicised organisation that is managed top-down from the highest reaches of the government. Everyone becomes a micro-manager on the most arcane issue.
Delivering health care in the modern world is indeed a challenge to all governments everywhere. The new UK government’s plan to redistribute control from the top to the bottom may or may not work – the devil, as always, will be in the detail and there’s no shortage of details when it comes to the NHS.
However, the principle is correct and one truism should guide policy – the bigger an organisation, the more inefficient and less responsive to ground level needs it will be. Successful organisations recognise this and adjust management structures accordingly. Just as local managers of the nation’s supermarkets stock their shelves as and when they need to meet local demand, so local managers of the NHS need to set their own priorities.
Some will argue that healthcare is different from grocery stores. But surely the provision of adequate food supplies is a more critical necessity than healthcare yet Tesco and its competitors more than meet the challenge without ever featuring in PMQ.
The big difference between the two is funding – at Tesco, the customer pays at point of delivery while, in the NHS, the government does. The real arguments at PMQ should be on this aspect – how to deliver the same result as Tesco but with a different pricing mechanism.
Only when PMQ and Newsnight no longer feature bedpan shortages will we know that British healthcare is delivering the goods at an affordable cost.