Apparently the NHS is inefficient in its use of capital assets. That's simple enough, we know how to solve this problem, we charge the people who use the capital assets for their use - introduce, that is, more marketisation to the NHS:
Hospitals could carry out 750 more routine operations a day if schedules were better organised, according to the finance watchdog.
The average surgery list wasted two hours a day last year, enough time to accommodate another 280,000 operations, according to an analysis by NHS Improvement. Surgeons questioned the figures, insisting that the main cause of cancelled operations was over-full wards.
It's even possible that the surgeons are correct here but that doesn't matter, charging them for the use of the operating theatres is still a good idea.
We have a scarce resource, operating theatre time. We wish to maximise the efficiency with which that resource is used. The answer is to charge people for using it.
This is not, of course, to say that Mr. Smith the ENT surgeon has to pay from his pocket for the use. Rather, we conduct an accounting exercise - as we already do in two other areas facing the same problem.
There's a limit to the amount of spectrum available in the country. That's why we get to bleed the mobile phone companies for what they use. But we're also going to, quite obviously, insist that MoD has access to some of that scarce spectrum. It's possible to simply assign what is asked for and forget it. But we don't - we charge MoD something like market rates on what they say they need. Purely on paper of course, the amount that goes into the MoD budget has to then cover the notional amount they pay back for the spectrum. But it does all concentrate minds wonderfully as to how much they should be demanding they have access to.
Equally with the roads. Yes, people do have to dig up the roads to stick pipes and cables in. So too do roads have to be closed to repair them. We charge people for that. Even when it's us taxpayers paying for a road to be redone, we charge a rent on the road to the contractor for the closure. Again, we taxpayers have to give them more money for the contract, money we then get back in that rent they pay for the road's closure. But that daily fee is set at the start, the number of days we expect being in the budget. It's amazing how much lower are delays on works completion once the contractor has to pay extra rent for each day of closure over what is budgeted for and in the contract.
It is entirely moving money around on paper. But even that works to optimise the use of scarce resources. So, if operating theatres are being inefficiently used then impose the same system on the NHS.
Why not? We know it works after all.