The Madness of King Nicholson

Since June 2009 the NHS in the UK has been told it MUST make 'efficiency savings' (cuts) of£20bn. The original edict came from Sir David Nicholson - then chief executive of the NHS and now chief executive of the all powerful English NHS National Commissioning Board. Since that time no one has been able to properly explain why these cuts are needed - and I mean proper evidence based reasoning. Many reasons have been given, and often they are ideological. The impact of the cuts are huge and indeed will affect patients and their illnesses so it is vital we hold politicians to account for their constant mantra of the need to cut the NHS budget.

I believe these cuts are hugely damaging to the NHS and are being used to degrade the service and soften it up and allow many more private companies to move in - in a similar way that the British railway system didn't have the investment it required in the 80s and 90s so it became a 'basket case' and the politicians could say 'look how bad the railways are - we will have to move the private sector in to save it'. Indeed after rail privatisation the cost to the taxpayer for their rail service has rocketed - something that commercialisation of the NHS will bring about.

Amongst the majority of those who work in the NHS it seems to have become the accepted norm that this £20bn savings 'just have to happen' and 'this is what we have been told to do' - yet no close analysis of why it needs to happen has occurred.

Remember in 2009 the NHS had the lowest ever waiting times and highest ever satisfaction ratings - an amazing achievement when you consider how much less we spend compared to many other countries. I found this most remarkable chart showing countries with their life expectancy and amount spent per person on healthcare - it is well worth a click. Link to full picture is here

So what reasons do we hear that the NHS MUST cut its budget by £20bn?

1. "We cannot afford the NHS any more"

The increase in NHS expenditure in the past decade was a huge boost to a public service that desperately needed investment. The investment brought about more nurses and doctors, newer equipment and lowered waiting times to a few weeks when in some places they had been around 2 years for a hip replacement prior to the funding boost.
Health is seen by most as a priority for our government and although we are in the midst of a huge banker induced global economic collapse there is still the will and the ability to pay for the NHS and not cut it. After all we spend far less now as percentage of GDP than we did when the NHS was actually created after World War II - as shown here...

We also hear how the country is in an economic mess and spending is unaffordable and we need to cut back. I am not denying we have a huge deficit - caused by our bankers - but we are the 6th richest economy in the world (World Bank figures) and maybe need to consider asking those who caused the economic crisis to dig into their pockets - rather than handing them even more money to go into their wallets. We should also ensure those who trade in the UK pay UK taxes in full in order to fund the public services provided in the UK. That is how we can fund our much prized public services.

2. "We are all living longer and need to change the way the NHS works"

Well we most certainly do need to change the way the NHS works. This is a non argument. It is an utter scandal that we see the health and social care budget slashed by government and the subsequent effect this has on our elderly.
It is incumbent on any society to look after those who are old and frail and at the moment we do not do this to the extent we could. There are far too few long term care facilities and support for our elderly population with dementia or debilitating illnesses. Those living at home struggle to make do with an hour here or there from a contracted out care provider.
It isn't good enough and the political parties need to sit down and sort this out. It is too important and too urgent to leave on the back burner.
The solutions were provided by the Dilnot Commission and can be found here. And if you think it is unaffordable then keep reading....

3. "There is a rising demand for healthcare"

As technology advances and our understanding of diseases grow then we discover new ways of treating diseases. New drugs are also discovered every year to treat disease and illness. This is great news for us all as it means when we fall ill there is more that can be done to help us get better.
But it will mean that healthcare costs more - social justice would dictate that we fund these treatments if they are safe and worthwhile. It is only right that we research new treatments and use these innovations but this is not an argument to say we need to cut the NHS budget - in fact it actually argues for the opposite.

So is the NHS bankrupt?

Absolutely not. In fact last year the NHS actually had a surplus as stated here by the Audit Commission. We have been told time and time again that any 'savings' in the NHS would be reinvested - indeed this was a motivator for many NHS employees taking difficult decisions in rationing or cutting services.

It is even stated on the DH website that the Nicholson 'savings' (or QIPP as they call them) would be reinvested in 'frontline care' - I am tempted to call this an untruth but may find myself at the sharp end of a lawyer if I do this.

NHS staff have been betrayed because last years surplus did not get ploughed back in to paying for the new treatments or new technology. The surplus didn't go to pay for more nurses. The surplus didn't pay for extra care for the elderly in society.
The surplus was scooped up by the Treasury and disappeared into the black hole of Whitehall never to be seen again.

So the Nicholson Challenge is actually a money making scheme for the Treasury under Mr Osborne as described by an ex NHS Finance Director here.

We should not be fooled by the Nicholson Challenge - we should demand the 'savings' (cuts) are re-invested in OUR NHS. This is such an important issue that we should lobby our MPs and spread the message far and wide.

It is madness - the Madness of King Nicholson!


PS Please do support my NHS Pledge - it only takes 30 seconds to do and I am going to use it to exert pressure on policy makers and politicians to better look after our NHS. It can be found here -


  1. What an appalling blog.

    Instead of synthesising all the key facts, it attempts to select a few gigantic misrepresentations of the truth in order to attempt to demonstrate things are as you wish they were rather than as they actually are. If it weren’t so important it would be hilarious.

  2. I don't know what planet Rolo_Tamasi is on. I thought this an excellent blog.

    First, the use of "efficiency savings" is linguistic contortion worthy of Orwell's 1984. Cuts is cuts is cuts, whatever you call them.

    And of course "we can't afford the NHS" is a lie. The NHS provides necessary healthcare at a very cheap rate - all other systems are more expensive. Of course, if we abolish the NHS we will, as individuals, have to fund our own care, rather than it being funded from taxation. Some of us may require less care than others; but on average we will pay more.

    Keep up the blogging, David!


  3. Dear David
    Thanks for the great blog. Keep up the good work!
    You and colleagues would be more than welcome at our next Wirral public meeting. Details on Facebook at:

  4. Excellent article, everyone should share it on Facebook.

    Keep up the goog work David


  5. Fabulous.

    Jut one thing: the politicians are being pulled up on this so, alas, you're not "immune" - you're confusing "deficit" and "debt". Two very simple things, though:
    - "deficit" is the yearly "poo": how much the UK spent more than it received *this year*.
    - "debt" is the ongoing, accumulated "poo" we're in - the overall amount we still owe, at the end of the say. All the years added up, as it were. The bank statement.

  6. Great blog well done , ignore Rollo one of trolls on twitter !


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