Winner of the New Statesman SPERI Prize in Political Economy 2016

Wednesday 14 February 2018

A comparison in accountability: Oxfam and the NHS

Although the original allegations in the Times looked weak, it turns out (from an interview with ex-employee Helen Evans by Channel4 News) that the leadership at Oxfam had not been giving the issue of exploitation by a tiny minority of its aid workers the attention it deserved. The deputy chief executive has resigned.

The original allegations concerned actions by some aid worker in Haiti some years ago. Oxfam took action at the time, and the charity has put in place various safeguards since. But nevertheless, it is important the media holds charities to account to ensure they do all they can to avoid this happening again.

But threatening to cut off all government funding is the last thing you should do. The message that sends to other charities is to hide any similar problems they come across in their own work, or worse still stop looking. Any responsible minister would have known that, but perhaps they wanted to get political points from their own side for being tough with a ‘leftie charity’. In none of the BBC coverage I saw (this story was the lead item on the BBC news I watched for four days running) were any questions raised about the government’s actions.

Contrast the behaviour of politicians and the media in relation to what is currently happening in the NHS. Quite simply people are dying because there are insufficient resources to cope with needs. Thousands have had operations postponed, leaving them in pain. Patients are lying in trolleys because there are not enough beds. Huge numbers, more than ever before, are having to wait for more than four hours in A&E.

The reason for all this is not mysterious. Health has been starved of resources by this and the previous coalition government like never before. I have shown the Kings Fund analysis in the past. Here is World Bank data up to 2014. The key point is that health spending as a share of GDP needs to rise to keep up with demand, but since 2010 the government has been shrinking the share of total output spent on health. The downward trend it shows until 2014 has continued and is projected to continue.

This shows neglect on a scale that make the leadership of Oxfam’s misdeeds look trivial. Yet where is the media scandal? The man who has been in charge of the NHS while this has happened and is happening in front of our noses is still in his job. The government continues to fail to provide the resources the NHS needs, while promising to protect the NHS, and yet it has not been held to account for killing people and leaving them in pain by the same media that has been happy to pursue the leadership of Oxfam. The Minister for International Development told the leaders of Oxfam that “an organisation’s moral leadership comes from individuals taking responsibility for their actions”. Quite.

The government are in denial about what is happening, and the media allow them to get away with it. Of course there have been countless reports about the crisis in the NHS, but we have not seen the kind of sustained and coordinated media focus on who is responsible that we saw with Oxfam. This is not about sexual exploitation in another country some years ago, but about people dying and in pain right here right now.

And incredibly, it is actually worse than this. The same politicians have attempted to use immigrants as a scapegoat for what is happening, whereas in fact immigrants provide more resources that could be used for health spending than they take out. Yet time and time again ministers can get away with this lie in the broadcast media. Worse still, one part of the government is busy preventing doctors the NHS desperately needs from coming to work here. And finally, I have never heard anyone in the broadcast media question why the government is starving the NHS of resources with such devastating effects. Its silence on the growing privatisation of NHS services is almost total, even though the vast majority of people do not want this.

This reminds me of the US election, where the media spent far too much time going on about Clinton’s emails and far too little time on Trump’s obvious unfitness to be a POTUS. But in this case there is no competing narrative, no two sides to balance. The media is simply failing to hold the government to account for allowing totally avoidable death and pain. This is what the UK has become in just seven years. A country that is happy to treat those who run charities as close to criminals, but shrugs its collective shoulders while the government destroys the NHS in front of our eyes.


  1. Taking on board the MM bias issue, but it is not the only or primary problem: the Labour opposition is hardly prominent in hammering home the issue. Why? Maintaining health expenditure at a rising real rate requires additional sustainable sources of tax revenue to be identified beyond corporate tax uplifts. It has been suggested that an ear-marked NI levy on employees and employers to finance the current health spending gap should be levied given relative public acceptance of paying tax for the NHS, but that would be another levy on jobs and would likely be regressive in impact in terms of employee contributions: a direct tax in reality imposed at a low ceiling and threshold.

    1. Labour have been very vocal about the NHS. The fact that you do not here that much about it should make you reflect on how the media treats this issue.

    2. No. Tax revenue is not needed to fund the NHS. That is logically and factually incorrect.

      Central government gets its money first from the Bank of England, which it owns.

      Then it gives it to the DoH, which then uses it to pay for goods and services like beds, buildings, medicine, on which VAT is collected.

      When a salary is paid to doctors and nurses etc. income tax is collected.

      1.Money created.
      2.Money distributed.
      3.Money spent.
      4.Tax collected.

      That is the order of play.

      And because central government can instruct the Bank of England to create whatever amount of money it needs, itinever needs to collect a penny in tax first to fund anything.

      And because central government owns and issues the currency via the BoE, it can never run out of money.

      It can never fail to pay its debts.

      It can never fail to underfund a service, except by wilful choice.

      So, if the NHS needs more funding, all Jeremy Hunt needs not do is ask the Treasury to authorise more funds to be issued from the Bank of England.

      The tax will then be collected after the money is spent.

      So, as you can see, once the correct order of play is remembered, it is easy to see that this government is wilfully choosing not to give the NHS money, and not on the basis that there isn't enough in the bank to give.

      There is no limit whatsoever as to the amount of money the government can have created and issue.

      As long as it collects tax when the money is spent, the currency will have value, inflation can be controlled, and the NHS can thrive.

  2. Hmmm.
    So according to your chart, we have increased health expenditure (as % of GDP) by 36% between 2000 and today (increase from 5.5% to 7.5%). Heartless Tory bastards.
    In the real world, we are discovering that death is not 'totally avoidable' and the more we avoid it the more medical costs we incur before the unavoidable occurs.
    The 'zero sum game' of NHS funding has probably come to a close. If you have a social conscience, spend some of your income on private healthcare.
    BTW, the charity sector is way ahead of you the motive for hiding wrongdoing.

  3. As I sat in the hospital waiting room two weeks ago a volunteer offered me from her trolley a drink, something to eat, or a newspaper.

    It was the Daily Mail.

  4. 'Its silence on the growing privatisation of NHS services is almost total, even though the vast majority of people do not want this.'

    Populus poll, January 2018: It shouldn’t matter whether hospitals or surgeries are run by the government, not-for-profit organisations or the private sector
    provided that everyone has access to care : Agree 64% disagree 19%


  5. I am enjoying what is clearly another in a series of spoof Dave-Spart posts, but on the outside chance that this is actually serious...

    The problem with the NHS is that the government has a clear conflict of interest. It is both purchaser and provider. and it provides on the basis of a monolithic institution. Hence there is no incentive for inefficiencies to be driven out through competition. the kind of controls and competition that have exposed inefficiencies and incompetence in companies like Carillion are missing so nothing ever gets better, and we are left with just one lever for improvement which is Give More Money.

    As an example, I am aware of a Mental Health Trust that has a missed appointment rate of 30%. Yes, that's right, 30%. No private company in competition with others could afford to have its staff idle for 30% of the time. They would find ways of reducing that number to something more acceptable. But not in NHS land; the solution to the problems of 30% missed appointments is the one and only solution available anywhere in the NHS: Give More Money.

    The correct solution is clear; adopt the more efficient schemes used in the rest of Europe; one where the state acts as purchaser through a state insurance scheme and more use is made of private companies to provide the services. If we spent the same amount of money through a scheme such as this we would see lives saved, so to adopt the kind of hysteria given in the post, refusal to allow more competition in the NHS is deliberately causing needless deaths !!!

    1. The NHS is one of the most efficient health systems in the world. The reason is that the staff can see that efficiency improves outcomes, and they care about outcomes.

    2. So that's the view of a Professor of Economics? That efficiency comes not from incentives or industry-sector structure, but from people caring a lot?

    3. I'm not exactly sure how the private sector would stop failed attendance rates, either. Perhaps it's also worth considering that a MENTAL HEALTH trust may involve patients who suffer from other causes of non-attendance, from anxiety about the appointment or lethargy to painfully ironic agorophobia and lack of transport suited to them (go on; try and get someone with an anxiety disorder to "just take the bus" to make attendance numbers look better).

    4. "I'm not exactly sure how the private sector would stop failed attendance rates."

      This can be said of pretty much any innovation. Before it is done you cannot see it. But with competition and incentive there would be an incentive to reduce the number. It may be that they could use video interviewing more than one-to-one interviews. It may be a call earlier in the day to see if the individual can make it and if not bring in others who can. Whatever - there would be an incentive to make maximum use of resources. To find a different way of meeting the needs of agoraphobics. In a monolithic industry with no competition there is only ever one answer - more money.

      I find it surprising that on an economics blog read by clever people I'm having to explain why competition encouraging innovation is a good thing. Do you all drive Trabants?

  6. and don't get me started on public sector pensions. Too late.

    taker a professor on a salary of £80,000 (about the average; couldn't find the mean), with an index-linked pension of 66%, then convert this to a fixed sum through multiplying by a buy-out rate of 22x (and I've heard of buy-out rates of over 60 so this is not exorbitant) and you get to a pension fund value of £1.16 million.

    So the NHS is being starved of funds because of outrageous pension commitments to professors!! I await John McDonnell announcing he is ending the scandal of millionaire public sector workers through a wealth tax on fat-cat professors to save lives in the NHS.

    Obviously I'm not waiting for that because it isn't going to happen. The first rule of Labour is its always someone else who is privileged and wealthy, never you.

    1. Don't get me started on the endless decline of academic salaries compared to the private sector. Academic pensions are provided by USS, which is a university not government scheme. The first rule with people who say the problem with the NHS is it is inefficient is that they do not know what they are talking about. In your case it appears to be generally true.

    2. The issue is whether opening up aspects of health care to competition would make it more efficient. It is hard to see how something that holds true in may other industries - competition produces benefits for consumers - would not hold in healthcare provision.

  7. Powerful and spot on. Why is the BBC such a whimp?

  8. What is happening in the NHS is a disgrace driven by Tory austerity policies and their fantasies about the benefits of the smaller state.
    I have no doubt that they would like to slash the foreign aid budget too.
    The incompetence of Oxfams top management have given them the political cover to do this.Time for a clear out at the top of Oxfam.

  9. I love the way you attempt to minimise the systematic cover up of the widespread sexual assault of vulnerable women and children

    1. You mean I minimise it by talking about how people are dying and in pain because of the actions of this government over the NHS. You would obviously prefer to ignore all this needless death and pain and just talk about Oxfam. What does that say about you?

  10. Not adding essential information but... I was angry reading Pres. Trump's comments about "people protesting NHS," indicating it was because they didn't favor national health care, not acknowledging the protests were often the failure of the British govt. to adequately fund the NHS and the perils of austerity policy.

  11. Your point is well taken, although I do feel that the BBC, at least, has been more critical of the government than you give them credit. That said, even if the BBC is not doing so badly, that doesn't mean they're doing well, much less that the rest of the media is doing a better job of holding the government accountable.

    As an aside and a very minor point, if I may. Your graph above shows that the UK is spending 2% more of GDP on public health compared to 20 years ago, vs an increase of 1% in France at the same time. So although I agree with you that spending has not kept up with demand, given the numerous measures we've seen and, of course, France started from a higher threshold (and probably has healthier citizens to being with), I'm not sure if this particular graph illustrates your point as well as you could have. Again, it's a very minor point, and I understand you probably didn't want to spend too much time on finding a better graph!

    1. I await to see a day the BBC leads on the NHS for 4 days running. As to the graph, I do not see your point. 1% of GDP is a huge number of doctors and nurses. Perhaps I should have made that clearer.


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