There is a lot more to public finances than just public service cuts, but on the other hand, there is a case for some cuts. So, let's do it.
How do we produce pain-free cuts in the NHS budget?
Managers amount to 3.1% of NHS staff. Their numbers have increased by 6.3% p.a. over the last decade, compared to 2.7% increase in other NHS staff. How do managers' wages compare with the average? On a par with doctors, sure, but rather more than cleaners. I am in the process of trying to dig out some figures. [update 30 March: Ah, here they are, dropping like ripe plums into my hand, from today's Guardian, A select committee found that £15.4 billion, 14% of NHS budget, goes on management and admin. An expert thinks that is average for health systems, but given that costs have been rising, (see below), is was less back in the day before the purchaser provider split.
So it is on management that the axe should fall, to heal in the budget deficit that everyone agrees must be healed.
The essential managers include those that service finance, buildings, and supplies. The rest are box tickers, meeting attenders, and such beauties "service development managers" - who are automatically surplus to requirements since there is no prospect for service development in the present climate. The product of the latter set is primarily to annoy front end staff by continually rearranging what they are supposed to be doing. A few can remain to service the staff proposals for efficiency changes, see the comment slot below.
In last week's BMJ, there are a series of suggestions for how cuts could be made painlessly. Everyone - consultants, GPs, ancillaries - had efficiency suggestions, but the only one who had nothing significant to suggest was the management person.
The NHS, like any large organisation, does need continually to be looking for ways to improve its way of working. The way to do this is through the good old Suggestion Box. Coal face workers can put in plans for improvements, which can be assessed by groups of their peers, and promising plans can be piloted and rolled out if successful.
On the subject of meetings, my local PCT meetings were seriously embarrassing in their pointless waffle quotient, as compared to the way local government meetings are conducted.
Tactical and strategic overview of NHS work can be made by ad hoc meetings of front line staff, each office electing a representative, and if necessary the representative meetings electing a representative, forming a communications web leading up to the Minister of Health.
The management of the NHS offers us a pair of juicy, low hanging plums that can be firmly grasped and snipped off without in any way damaging the tree.