Adam Smith dismissed the idea in the Wealth of Nations that international success could be achieved by a “nation of shopkeepers”. Instead, government should be “influenced by shopkeepers”, i.e. business people. His point was that government should back practical business people to get on with what they do well and not indulge in talking shops producing “strategies” that never happen.
A fine example of that distinction is the Department of Health and Social Care (DHSC) announcement on 27th February of “a new National Genomic Healthcare Strategy”. Clearly mapping genomes to detect inherited (potential) health problems and finding ways to treat them even before the symptoms arise, is a great idea. The government is right to support promising research in this area. So what, you may wonder is this “strategy”? Read down to the end of the press release and it turns out that no such strategy yet exists. The Minister said: “In order to make this a reality, I am delighted to announce that we will be working with the National Genomics Board and the broader genomics community to develop a National Genomic Healthcare Strategy.”
The National Genomics Board has 26 great and good members albeit not great and good enough to report directly to the DHSC: “The National Genomics Board will report to the Life Sciences Council via the Life Sciences Industrial Strategy Implementation Board.” The Genomics Board has its own advisory panel and then , there is the Genomics England Board which also “has several independent advisory committees that report to the board.”
And one must not forget the also recently created UK Rare Disease Policy Board and Forum. Genomics and rare diseases are intimately bound up since the former is expected to provide the solution to the latter. The UK Strategy for Rare Diseases reads as follows: “Each country in the UK will take action and develop plans to implement the strategy that best meets their own health and care systems, but will work together where it makes sense to do so.”
While the DHSC has been busy building all these new talking shops, NHS England has actually been doing something. Last July, the Chairman of NHS England reported, inter alia: “The design of the new phase of roll-out of a genomic medicine service in the NHS in England, following the successful conclusion of the 100,000 Genomes Programme. We have been undertaking a procurement process to establish seven genomic laboratory hubs, building on the 13 Genomic Medicine Centres that we set up under the 100k Genomes programme, with a view to transforming the highly fragmented pattern of genetic testing in the NHS into a national network of regional provision, with standardisation of testing through the roll-out of a National Genomic Test Directory. Genomics England Ltd., a wholly Government-owned company, is our partner in procuring sequencing and analytics.”
This plethora of DHSC talking shops, many created recently, interferes with the ability of the NHS to do its job. Judging by the variety of figures it cites, one wonders whether the DHSC even knows how many it has. Take Health Education England, for example. It has 2,000 staff and a Chairman paid more than the Prime Minister. It claims to create new clinical staff and train the existing staff but in reality it does neither: it simply hands out the NHS’s money to the universities and professional trainers who do.
The NHS, like any other large organisation, would be perfectly capable of doing that for itself and the taxpayer would save £5bn. a year if it did. That’s a healthy sum to save.