Bernard Ingham: Radical surgery is needed as waste drains NHS's blood '“ and makes mine boil

Last week the nurse came to extract our blood on two separate days and, exasperated with her management, asked if we knew that each visit cost £40. In other words, the NHS had once again wasted £40 on us.

I know that a more economical approach to this service would not solve the NHS’s problems. But I wonder just how much might be saved by managers who did not live in a compartmentalised world and treated the public purse like their own.

While I have precious few complaints about NHS treatment over the years, I have had my doubts about its management since the 1980s.

Margaret Thatcher discovered that there was no effective control of stocks, notably of bedding, and brought in a Marks & Spencer boss to sort it out.

According to the Public Accounts Committee, he did not end the NHS’s wasteful, chuck-away attitudes. Instead, we have since had endless tinkering with the NHS’s structure and the multiplication of managers.

It would not be so bad if the NHS were consistently well run. But we know from a succession of scandals, for example in Staffordshire and Cumbria, that it is not.

It is distinctly patchy yet, according to last year’s figures, 70 executives of the new regional bodies introduced in 2013 to control local NHS budgets earn more than the £125,000 maximum recommended by the NHS.

Twenty, including nine specialist doctors, took home more than the Prime Minister’s £142,00. One cost £280,000, including fees to a recruitment agency.

Worse still, some received generous redundancy payments when primary care trusts were abolished, only to walk in to similar roles in clinical commissioning groups. Is structural tinkering driven by public health or managers’ wealth?

Whatever, it is disgraceful, though par for top management, public or private. It cossets itself magnificently and to hell with the poor bloody infantry who are allowed, in the NHS, only one per cent pay rises. It is a denial of leadership. As a consequence, NHS top management has no moral authority to ask anything of the staff. Instead, it calls on the Government for more resources, no doubt partly to lavish on itself.

Indignant though I feel about this abdication of responsibility, I again do not kid myself that by bringing management salaries and redundancy pay within reasonable compass, the NHS could look ahead to a bright future.

The problems of a service free at the point of delivery with an ageing population, uncontrolled immigration and continuous medical developments are graver than that. It is already under pressure before winter arrives.

Its future is bedevilled by its status as a national sacred cow that inhibits the debate of options. This is highly convenient for managers who pass the buck to politicians.

It falls to chief matron – and how we miss them – Theresa May to sort out this mess. She will get no help from Labour. Indeed, spendthrift Corbynistas seem to have inveigled themselves into key positions in the BMA junior doctors’ panel.

As a mere patient, I suggest she decides what proportion of the national GDP can be afforded for the NHS, thereby giving everyone an incentive to increase our wealth and also the number of doctors and nurses.

To help cut the NHS coat to the cloth available, I suggest that in identifying priorities we:

eliminate or severely ration such things as free cosmetic surgery, except where psychologically necessary;

end NHS “tourism” for nationalities who overall owe us the cost of their treatment;

make treatment for the obese, smokers and boozers conditional on their reform as result proposed by Vale of York doctors;

charge drunks the full cost of A&E treatment;

encourage all who can afford it to take out private medical insurance while making it clear to medics their first duty is to the NHS;

stop the NHS pay, perks, redundancy, “temporary” re-employment and locums rackets and ensure salary guidelines are observed;

publicise – not just publish – the wide variation in NHS performance and summarily sack failing managers;

educate the public to use where possible chemists, GPs and minor injuries units instead of A&E departments, making sure GPs are available round the clock.

Let’s cut the cackle. The NHS, a wonderful concept, needs managing properly so that not even £40 is wasted on unnecessary visits. After all, people’s lives are at stake.