The Telegraph has a blog posting by Daniel Hannon warning America not to copy the British health care system. Amomst the comments, I found one by Blank Xavier with these startling numbers:

In 1948, when the NHS was formed, there were 480,000 beds and 350,000 staff.

By 2002, there were 186,000 beds and 882,000 staff.

As of September 2008, there are 160,000 beds and 1,368,200 staff.

Ann Keen, the Health Minister, said; “The NHS workforce is now at record levels and has increased by almost 300,000 over the last ten years.”

The NHS is now the third largest employer in the world; surpassed only by the Indian National Railway and the Red Army.

Well, one cannot take an anonymous quote at face value, so I did a little research.

A lot of googling lead me to this critique of the NHS, which confirmed most of the figures cited by Xavier. The critique is entitled “Gammon’s Law of Bureaucratic Displacement”, and is worth quoting extensively, because it explains the statistics quoted by Xavier:

My initial contribution will be to provide you with evidence of a disorder which for the past fifty years has been slowly but surely destroying our medical services in Britain. I say destroying our medical services rather than destroying the National Health Service, because, as I hope to show, it is the National Health Service itself which is the destroyer. The destructive process involves the progressive displacement of productive activity by non-productive and often counterproductive bureaucratic activity.

Before presenting my evidence I should like to correct a widespread and very damaging misconception: bureaucracy is not, I repeat is not synonymous with administration. By bureaucracy I mean a rigid system of human organisation governed by fixed rules and tending to exclude individual initiative. By administration I mean the guidance and facilitation of an enterprise. And this should be the very opposite of bureaucratic. The tragedy of the NHS is that it is an inherently bureaucratic organisation which imposes the bureaucratic mode of operation on all who work in it.

Two short stories will show what I mean by bureaucratic displacement. Some years ago I worked in a small hospital just outside London. The quality of the nursing on one particular ward was outstanding. I returned a few years later to find the ward in chaos. When I asked for the Sister who had previously run the ward so superbly I was told that she had been moved into administration. I found her in an office and she wept as she told me that she had been forced to leave her ward and become an administrator since her salary would have been reduced and fixed at a low level if she had remained in her clinical post. The focus of nursing had been changed from the ward and the patient to the office and the seminar room. The intimate care of patients had come to be regarded and rewarded as a menial task, a preliminary stage in a nursing career which was now seen to be essentially that of management as my second story shows.

Walking along a wide corridor in a London Teaching Hospital with which I was unfamiliar I asked a person in nursing uniform the way to a certain ward. “Oh, I don’t know where the wards are, I am in administration” she replied as though I had insulted her. She turned and walked through some glazed doors which opened on to what had been a long Nightingale ward. It was now divided into a multitude of open-plan offices. Meanwhile in the A&E Department on the floor below patients were lying on trolleys for up to 48 hours and others were having their operations postponed owing to shortage of beds, Two examples of bureaucratic displacement. Politicians dismiss such stories as ‘anecdotal’ – by that they mean that they relate to real people and real events rather than to statistics. So let us take a look at the statistics.

When the NHS was established in 1948 we had 480,000 hospital beds. By the year 2000 the number had fallen to 186,000. This represents a fall from 10 beds for every thousand of the population in 1948 to 3.7 in the year 2000. It means that we often now have insufficient hospital capacity for prompt investigation and treatment even of first class emergencies. According to the official statistics we have just under one million patients waiting for hospital admission. There is no margin for handling epidemics and admissions for elective surgery are frequently cancelled owing to lack of beds. In an attempt to deal with this state of constant crisis patients are now being sent to France and Germany for their operations. And still the number of NHS beds is falling.

As for staff, the number employed by the NHS has more than doubled from 350,000 in 1948 to 882,000 in 2002. The greatest percentage increase has been among designated administrative staff. Between 1997 and 2002 Senior Managers and Managers increased by no less than 47.6% compared to an overall increase in the workforce of 16% (nurses increased by 1.8%) But these figures reveal only the tip of the bureaucratic iceberg. For example large numbers of nurses are now wholly engaged in management but are still counted as nurses. Of even greater significance is the proliferation of bureaucratic procedures involving all staff, progressively displacing their productive activity. And now, here we come to the heart of the matter.

Nearly thirty years ago I discovered a close correlation between the increase in the numbers of NHS administrative staff and the fall in numbers of NHS hospital beds that had occurred over the preceding nine years. For statisticians: linear regression analysis showed a correlation coefficient of -0.99. For non-statisticians I should explain that this figure represents an almost perfect correlation between the growth in numbers of administrators and the fall in numbers of beds.

A statistical correlation, no matter how close, is not necessarily significant. However I suggested that this correlation could have an important explanatory value if the number of designated NHS administrators was proportional to the bureaucratic activity of the NHS workforce as a whole. The correlation of the growth in numbers of administrators with the fall in the number of beds would then follow from a progressive displacement of productive activity of all NHS staff by the proliferation of useless and often counterproductive bureaucratic activities throughout the whole organisation. In this way, an expanding workforce and increased spending would be matched by a fall in production; the more that was put into the system the less would come out of it, a process I likened to the implosion of a black hole.

Yet Obama’s health care guru, Tom Daschle, admires the NHS, and the Democrats want to impose a similar system in the US by stealth legislation, some of which was included in porkulus.