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The NHS: victim of Treasury Syndrome

With a shocking 500 unnecessary deaths per week due to delays in getting medical attention the Treasury’s wilful blindness persists

Dr John Carlisle by Dr John Carlisle
06-01-2023 09:27 - Updated on 08-09-2025 11:56
in Economy, Health, Politics
Reading Time: 6 mins read
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Image by John Carlisle

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In order to best understand why Rishi Sunak, Steve Barclay, Suella Braverman, Jeremy Hunt and Grant Shapps are such failures as ministers you need to look at their performance through the lens of negotiation. They are really dreadful negotiators. In all my 40 years of studying negotiations and training negotiators I have never come across such ineptitude in any organisation anywhere in the Western world.

I was about to offer advice when it struck me that actually they are wilfully blind to the idea of negotiating. They prefer to play the ‘win/lose’ game, so why waste my time. The trouble is that win/lose always leads to lose/lose, or to use a military term: MAD (mutually assured destruction). That is where we are headed with the NHS and transport, because their egos are so big and their compassion for the people so low, that they just do not care.

This phrase wilfully blind first emerged in a 2011 book, Wilful Blindness: Why We Ignore the Obvious, by business leader and author, Margaret Heffernan. She first applied it to the chair and CEO of the disaster that was Enron, whose bankruptcy lost the shareholders £52bn in four years and shook Wall Street and politicians to their core. Yet, the test and trace programme cost £37bn in half that time, with dismal performance, and the government just shrugged.

Wilful blindness and the Treasury

Wilful blindness is the refusal to see the need for something because you do not wish to address it. So, the issue is that the sample of Conservative politicians named above are playing a win/lose game with the unions and, inevitably, with the public.

What is behind this?

It is the Treasury culture of cutting public sector costs; the biggest victim of which is the NHS. The biggest losers are the patients. As of today, it is estimated that 500 people a week are dying unnecessarily because of delays. That is 26,000 a year, just 2,500 fewer than the 28,500 lives that were lost in the London Blitz. The figure marginally exceeds even the shockingly high South African murder rate.

Does the government really understand the enormity of the nation’s losses due to its lack of funding and planning? Does in excess of 70 deaths a day, 70 grieving families, not shock you?

When I was training at the civil service training centre in Sunningdale, I was told by a senior civil servant over dinner: “The Treasury is where good civil servants go to lose their souls”. My experience has been exactly that.

One of the main reasons for this is that the Treasury is the only ministry that does not actually provide a service to anyone. It has no customer focus whatever. It is not charged with adding value to the service user. It only sees itself as a power broker, using money to influence or even create policies. Its favourite words are cost, inflation, national debt, GDP, cannot afford, etc. Its least used words are need, real demand, value. Heartless!

uk
Politics

Is the UK a failing state? A tale of two countries

by Dr John Carlisle
23 December 2022 - Updated on 27 December 2022

Toxic meddling in the NHS

The NHS has been brought to the brink – by the Treasury and by terrible leadership, beginning with George Osborne’s totally misguided austerity policy.

Then the toxic meddling began with Andrew Lansley’s 2012 bill, turning the NHS upside down just when it had received the highest patient ratings for 40 years! A key disrupter was the procurement policy focused on lowest cost tendering, the worst form of contract, inviting delivery failures, but the Treasury approved it on the basis of ‘cost reduction’. This became an open door for privatisation.

Then came Sir David Nicholson, the NHS CEO’s challenge to save £20bn by 2015. Note, it was not to provide extra funding to social care or to reduce bed delays, or to increase staff and beds, which is what patients and staff needed. The number of bed delays and costs shot up, but the cost-cutting, which actually increased aggregate costs, pleased the Treasury. Nicholson was awarded his knighthood. Job done!

There is not enough space to cover the reorganising damage his successor, Simon Stevens, did, which deflected care imperatives. But it is worth reflecting on the damage Jeremy Hunt did, both to morale and to performance. He insulted junior doctors until they went on strike. He allowed the cancellation of the nurses’ training bursary by wilful Osborne in 2016. This resulted in a shortfall of 13,000 applications for degree courses and 40,000 unfilled positions. He did not listen to the medical staff, and again, would not negotiate, playing the win/lose game.

Image by John Carlisle

We have the wrong leaders

In 2019 Boris Johnson had to climb down and reverse the bursary policy. But the damage had been done, and between Brexit and a very incompetent home secretary regarding overseas nurses, there are today 50,000 vacancies at a time of a major national health crisis.

For the first time ever, nurses are now striking for a pay increase and the prime minister’s response is that he is “sad” and “disappointed”, but he insists that refusing to negotiate is the “right thing” in the long term.

This is the action of either a very frightened or a very arrogant man who, because he has never held down a job that requires planning a production or service process thinks this is ‘leadership’. His vision to champion maths at this point in time really is fiddling while Rome burns.

Thus he and Hunt, who is now pulling the levers of power in the Treasury, while at the same time pontificating on the NHS he mismanaged for six crucial years, are exactly the wrong leaders the UK needs. They all need to go now and let the union leaders navigate us out of this dreadful government-created mess.

    Great read!  Let me buy you a coffee.
Tags: NHS

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Dr John Carlisle

Dr John Carlisle

John Carlisle is an adviser and activist in private and public sector collaborative system change. His company JCP was the largest provider of collaborative projects in Europe in the 1990s. Now retired, he is an NHS activist and works on economic reform especially in the public sector. He became best known for his success in organisational transformation through cooperation, e.g. BNFL, British Rail, Welsh Water, De Beers, etc. John was chair of the Leadership Development Institute at Rhodes University in the 2000s and visiting professor at the Sheffield Business School from 2006 to 2013.

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