Decades of Mismanagement Are Dooming Britain to Decline

It seems that not a day goes by without further confirmation that the Government has been totally incompetent for decades – so this is an observation not confined to any one party.

The most recent news is the pending disaster in many buildings, entirely due to the use of a special reinforced aeriated concrete (RAAC) from the sixties onwards, which was known to have a shorter life than normal building structures. It was highlighted in 2018 and it would appear that in spite of this tsunami of consequences that would be inevitable very little has been done about it. The implications for education could not come at a worse time, after education at school, college and university level was already irredeemably damaged by the completely pointless and unnecessary lockdown imposed by ministers. In this they had very little justification, other than recommendations from an extremely incompetent and not fit for purpose Chief Medical Office and SAGE.

No need to remind everyone that Sweden did not close schools yet it had one of the best outcomes of all Western nations, without a single day’s education being lost for its schoolchildren and one of the lowest death rates from Covid and the consequences of lockdown in the Western world.

It has been asked why, since the issue with schools and RAAC was known in 2018, weren’t the schools all inspected and catalogued while they were closed.

A crisis in education has been building every since the Tony Blair mantra of “education, education, education” was translated into a goal of 50% of all students going to university. For some years it has been clear that this has resulted in far too many people going to university to do totally unnecessary degrees and be saddled with lifelong debt that in the majority of cases the taxpayer will be picking up. The law of unintended consequences means that many of these students who have wasted three years and tens of thousands of pounds for a degree that has no use have deprived the workforce of no doubt very able-skilled workers. This is why we now have a situation where there is an enormous shortage of useful skilled personnel with enormous impact on the building industry and maintenance experts. A further consequence of this – I’ll leave it to you to decide how unintended it was – was to flood the country with such workers from abroad, particularly the EU, and turn a blind eye to the consequences.

The NHS, which is the country’s biggest employer and for which plans have been announced to make it up to 50% bigger in personnel terms, has not benefitted from any university expansion for medical students, resulting in a severe shortage of doctors.

No minister could possibly deny the changing demographics, whereby the population for the last 20 to 30 years has become older and more infirm, requiring more and more resources. In spite of this, the Government refused to open the number of places for medical students in the U.K. on the grounds of cost, which has resulted in having to import more and more doctors from abroad, often on agency contracts costing three times the price of normal salaried personnel.

The situation for nurses is probably even worse, having adopted an ill-thought through plan to train all nurses to degree level. Good nurses do not need degrees and the NHS was supported previously by an army of nurses who trained on the job and more importantly were paid. How on earth do we expect to have enough nurses when not only do they have to undergo a degree but also pay for it. Steve Barclay is another Health Minister in a long line of Health Ministers, all the way back to Ken Clarke, who have instigated major reforms of the health service, most of which have backfired or are clearly not accruable – in Barclay’s case, gladly informing a meeting of health professionals that his department had employed 40,000 nurses for the NHS last year while omitting to say or explain why 50,000 had left. If this continues, it is clear there will be no nurses in a very short time. The major management reforms, which appear to be continuing with no loss of momentum – such as a recent decision to employ super regional managers at nearly £300,000 a piece in order to address a severe shortage of staff on the frontline!

Over-management, de-professionalisation of doctors and complete destruction of morale in frontline staff have been the approach that has been pursued relentlessly over the last decades. The NHS has been made to suffer waves of reforms, with change after change and no sense of irony at the wry observation that things are bad enough as they are. The constant change in doctors’ contracts, again, like education, goes all the way back to Tony Blair who destroyed the GP services in the country by giving them a contract that allowed them to opt out of night and weekend care for a very small change in income, which nearly everyone accepted. I now find that constant change in contracts is a major reason why the NHS is failing so badly, with not only millions on the waiting list but also the numbers dying on it ever increasing, arguably because of management neglect. 

One of the reasons for the inability to bring the waiting lists down, which many predicted would be the obvious long-term effect of a lockdown (even if it had only been a few weeks, as promised), is the sense of injustice and need for recognition by all medical staff. In the junior doctors’ case they have for the first time in years elected to go on a series of rolling strikes. What has been most amazing about the strikes is that they have demonstrated that they are already working to rule and are nothing like the junior doctors of my generation and, indeed, many since. One director of a major surgical service told me that the hospital operates much more efficiently without the junior doctors as senior doctors can go in, diagnose and treat within 10 minutes, as opposed to an hour plus for junior doctors’ engagement.   In the old days there was a ‘Firm’ system where every junior doctor was formally attached to a team of consultants and senior registrars, which not only enabled good education, teamwork, feedback and so on, but was also fantastic for mentoring and support – things sadly lacking today, resulting in professionals going off on sick leave far more commonly than used to be the case.

However, appallingly bad decisions like these are not confined to education and the NHS but seem to permeate the whole of society.  When I grew up everybody had faith in the ‘system’ in that the civil service was competent and would deliver in all areas, from truth and justice and police competence to belief that their tax concerns and pensions would be dealt with swiftly and properly. However, it would appear not any more. It is clear that the Civil Service and the increasingly wasteful and completely useless local governments have, in many cases, been infiltrated by specialist groups and ‘charities’ campaigning for rights, which has resulted in a raft of legislation protecting minorities. Although initially justified, this has gone on to be a rolling behemoth, infiltrating every administrative aspect of the Government and effectively paralysing it.

Another obvious analogy is the way the Government displaced reinforced concrete with a much poorer substitute, leading to the inevitable collapse that we are now starting to see in buildings. Many fundamental aspects of society have collapsed or are on life support in the U.K., mainly due to the unintended consequences of Government actions going back decades. The problem with transport is everywhere to see and involves trains, main roads and even urban movement, whether it be in constant strikes or the almost permanent feature of dangerous and damaging potholes in every city and town that I have visited in the last few years. Even flying, with its impeccable safety record to date, is suffering from the lack of an upgrade in the air traffic control system in this country, while also reeling from strikes across Europe and in the air traffic control networks, adding to constant inefficiencies.

Then there is the water and sewage facilities. Privatised under Thatcher to improve the service and keep future costs off the book, this has led to total privatisation, leading to the opposite of what was intended. Whereas all the money was meant to be used efficiently for improvements and keeping all the infrastructure up to date, having the vision to repair ahead, we now have a crumbling, failing system where the money that should be spent on investment now goes in enormous dividends to the overseas investors who have bought most of these companies.

It is just as bad when it comes to gas and electricity – witness the crumbling gas infrastructure, which greatly contributes to the numerous roadworks in every region in the country, as well as the crumbling national grid, which cannot possibly cope with the Government’s electrification Net Zero plan. The decision to close down power stations long before there were reliable replacements is inexplicable given the unreliability of renewable energy generation in the absence of the ability to store it.

Thus, it would appear that the country has been beset with poor government for at least two and half decades, with political parties and Government ministers who have failed to think through the very obvious consequences – unintended and intended – of many of their actions. Did they think such strategic thinking was not necessary as the problems would not manifest until they had long since gone from office? It certainly now feels that all the chickens are coming home to roost. Virtually nothing that we used to take for granted, even as recently as the 1980s, is working any more. The very worst aspect is that there is a permissive miasma that nobody really seems to care or that nobody, more importantly, is being held responsible and to account for all the numerous failings.

Angus Dalgleish is an expert in immunology and Professor of Oncology at St George’s Hospital Medical School, London.