The BMA, the British Medical Association, tells us that the NHS, that National Health Service, needs another £9.5 billion stat. That is, the trade union for Britain's doctors says that the employer of near all Britain's doctors should have lots more money.
Well, yes, OK, that's what unions are for but we do fear that they've rather got the wrong end of the stick:
Dr Mark Porter, the BMA’s chief, said: “These figures are especially concerning given that everyone can see a huge crisis unfolding within our NHS, with record numbers of trusts and GP practices raising the alarm to say they already can’t cope.
“The NHS is at breaking point and the STP process could have offered a chance to deal with some of the problems that the NHS is facing, like unnecessary competition, expensive fragmentation and buildings and equipment often unfit for purpose. But there is clearly nowhere near the funding required to carry out these plans.”
It's the unnecessary competition and expensive fragmentation that betrays the error here. For as Adam Smith pointed out those 241 years ago, long enough for people to grasp the point, we become richer through the division and specialisation of labour. Yes, that damn pin factory.
This does indeed apply in medicine - the literature is chock full of research showing that hospitals which do a lot of one type of operation have very much better results than those which occasionally dabble. That doctors themselves study certain specialties is again proof that the specialisation of labour applies here.
One of us here at the ASI spent a decade as the only person in the world doing a specific job. One part of the lighting industry uses rare earths to alter the colour emitted. That unique job was making sure of a supply of just one of those rare earths to that industry. No, not mining it, not processing it, not turning it into light bulbs, just ensuring that there was a supply of the right purity, in the right size, in the right place at the right time. That's the sort of granularity which private industry gets to these days. Just the one person in the world doing a specific task - OK, that level of granularity is still pretty odd but still, that's the possible end point of the process.
Fragmentation is not thus expensive, it's the process by which we become more productive and thus richer. And competition is just the method we use to decide who we are going to divide and specialise with.
Thus we really do conclude that the BMA have the wrong end of the stick here. The very things they are complaining of are the very things which, in every other walk of life at least, make us more efficient. And if it works everywhere else there is no reason at all why it won't work in medicine.