Dalrymple again finds corruption and dishonesty in the NHS bureaucracy:
[Chief Executive of NHS England Sir David Nicholson] admitted, however, that no one would know exactly how many people had been made redundant and then rehired somewhere in the NHS as a result of the reorganisation,
‘CCGs [clinical commissioning groups*] do not collect that information in the same kind of way. I don’t have that information.’
In fact he doesn’t have it approximately, let alone exactly, because no one has an interest in knowing it; everyone, rather, has an interest in not knowing it.
Everyone who has worked in the NHS is familiar with redundancy payments to managers as a prelude to their promotion elsewhere in the service, irrespective of whether or not a reorganisation is taking place. (Reorganisations are necessary before the failure of the last reorganisation becomes incontrovertible.) Ever since Mrs Thatcher introduced general management into the NHS, it has been [an] inexhaustible well for bureaucratic looting and self-enrichment.
But, of course. How could it be otherwise? The challenge of management is to incentivise each individual actor to act in the interests of the whole, also referred to as the commons, when every individual actor would otherwise act in their own interests, even at the cost of destroying the commons. No one has solved the problem of how to incentivise the managers who must incentivise themselves to act in interests other than solely their own. The failure to do this is the only ultimate cause of the collapse of nations, though many proximate causes may be misleadingly pointed to. And thus we are witnessing the rapid decline of the West, not just the NHS. It’s all going down the tube.