Oh! Don’t get me started SP
Firstly, I think the pandemic really exposed how ultra weak was the government. No-one got to grips with proper leadership and the costly measures introduced seemed owe more to a panic response than a well thought out plan.
Now, the NHS
. Black hole, indeed, both in terms of inefficiency and money poured in. I think that the thing has grown into a massive monster that is far too big to be directed centrally and that is responsible for the waste and inefficiency. I would break it up and divest the centre of any management power below the strategic level, giving far more autonomy to regional level and below. Proper accountability measures would be in place. Aside from setting and monitoring the top level aims and associated strategy the centre would be a service provider (purchasing etc) but as a responder rather than director - nothing else.
I have some sympathy with this view, barjon, but there is definitely a place for centralisation - particularly in the area of an holistic IT capability across the country.
The problem is, the IT systems in the Health Service almost never work properly. Whoever in Government awards these contracts, almost inevitably hands them out to rapacious consultancies like Accenture or Deloitte (likely after several long, 'working' lunches and/or hookers and charlie).
I ran part of a large FS contract for one consultancy, and they basically staffed 90% of it with graduates - most of whom had degrees in Classics, Bio-Engeering, Languages, or Sub-Saharan basket-weaving.
Said grads were eager-beavers, no doubt (churn was high, as the consultancy worked them until they couldn't go on any longer), but they were clueless when it came to the actual subject matter.
The consultancy op model was to get the minimum possible amount of SMEs in place, complement them with an army of relatively-cheap, unquestioning drones, have an absolutely GOLD-PLATED legal contract with the client, and hoover-up as much margin as humanly possible.
A successful outcome was always somewhat of a secondary consideration, and if the client wanted to withhold payment for a given milestone, they would simply wheel out their legal team without hesitation - at which point the client generally backed-down and paid, because who needs the pain in the arse of a legal bun-fight, when your day job is as an IT guy.
This an MO these consultancies carry into all industries, and they're very successful at it too. It's just a shame that their profit margin usually comes at the expense of an incredibly-poorly implemented end-product, which the client then has to patch together to try and make work (or ultimately replace at great additional cost).
This is just one example of how 'waste' develops in the Health system. Track & Trace and PPE provision are two more contemporary examples. Importantly, none of these aspects are in the direct control of the people who work in the NHS.