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Knowledge is power….
… ignorance is bliss.
Take yer pick.
Personally, I quite like to know what’s going on. How are Streeting’s reforms doing?
What’s actually going on?
Err... nothing.
Nothing, if you ignore chaos, confusion, a bewildered DH+. Some people leaving, some staying… no one really knows who, what or when.
The flotsam we call the NHSE Board, clinging to the wreckage of the 8¼ year plan.
Our very own Macbeth-Boy, is consumed by ambition… his hamartia. Without the courage to make Starmer his Duncan.
He’s best ignored.
The NHS?
Doomed to soldiering on, pretending £120m sprint, will solve the waiting list crisis.
We are being swept into;
'... symbolic action and propaganda to influence politics, consumer choices and corporate image...'
the territory of;
‘The conscious and intelligent manipulation of the ... opinions of the masses ...’
The work of Edward Bernays.
In 1928, with his book, Propaganda, he ‘invented’ modern PR, political messaging and agenda setting.
Ouch.
Silly-Boy has been a failure...
... he had one job. But...
... he cannot see that the politics of waiting lists is very different from the mathematics of waiting lists.
The NHS operates on the physics of demand and capacity.
Politics operates on the management of expectations…
… the £120m effort to boost diagnostic activity, is 24 carat Bernays.
It sounds purposeful; more tests, more evening, more weekend sessions, more effort, more more.
The public thinks ‘momentum'. The actuality, the arithmetic? A different story.
Waiting lists are not really about activity. They are about balance. The list only falls when the number of patients treated, exceeds the number of patients joining the queue.
Politically, diagnostic expansion is irresistible. The public thinks ‘more’. Tests are visible activity.
Big numbers and millions of pounds.
Impressive headlines. The sense… the system is moving. We fail to ask; ‘to where?’
Diagnostics; do two different things.
Some reassure patients. Yer OK. Go home. Get on with yer life.
Others… identify disease and send the patient deeper into the system.
A reasonable working assumption; 40–60% of additional diagnostic activity will generate downstream treatment demand.
If we assume an average blended, marginal cost of £300–£400 per diagnostic, then...
... £120m funds roughly 320,000–430,000 extra diagnostic tests...
... if half convert into treatment, that's ~185,000 patients...
... who would join ~1.7m monthly referrals, when...
each month, ~1.4-1.6 complete treatment.
Roughly 12–13% of a typical month’s treatment volume. Unless there is matching treatment capacity, this diagnostic surge challenges;
- theatre capacity
- workforce gaps
- bed occupancy (90%+)
The system faces a classic bottleneck shift.
You shift the constraint from waiting for diagnosis to waiting for treatment.
Even if some operations are shifted into the private sector, I'd venture it means 60,000–75,000 additional NHS procedures.
£129m is not enough to fund both diagnostics and large-scale treatment expansion.
The public sees activity; the system quietly generates more work.
The policy is not wrong. It’s clinically desirable. Often essential, but…
… it does mean that this diagnostic surge is unlikely to automatically translate into shorter waiting lists, unless...
... treatment capacity grows in parallel, but…
… politically, the story is compelling.
Public understanding is shaped less by system data and numbers. More by visible effort...
... if the government announces extra clinics, extra tests and extra funding, the intuitive conclusion is that waiting lists will fall. Effort is equated with effectiveness.
The communications strategy reinforces this, and...
... shifts attention away from the underlying queue of patients waiting for treatment.
Few people will track the balance between referrals and treatments. Fewer still, think about how diagnostics convert into treatment demand.
In system terms, diagnostics accelerate demand entering the treatment backlog.
Most of the public rely on a simpler picture;
- hardworking staff,
- more money,
- more tests,
- more operations…
… it feels like progress.
This is why politicians believe, the public believe; waiting lists will fall before the next election.
The uncomfortable truth is that record activity does not necessarily mean shorter queues. It may simply mean the queue is moving faster while continuing to grow.
That gap between perception and system-reality is where the politics of the NHS is stranded.
HMG must show momentum.
NHS must deal with the maths, and the public…
…to borrow from Bernays;
'they will go where they want to be led.'
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