Scandals within the NHS have finally made us question the angelic halo of our doctors

Much of the narrative around the health service over the past few years has depicted nurses as angels and doctors as living saints.

Soap operas are helpful purveyors of this narrative. Perhaps the most famous is George Clooney as the charismatic Dr Ross in the long running American medical drama ER.

Dr Ross, despite the similarity in the name, is very different from Dr Rowlf, a character from the Muppets, who takes part in a recurring sketch, the Veterinarian’s Hospital, where a group of animals pile in and week after week operate on patients. They never did find a cure and the outcome was often a disaster.

In reality, the NHS is a mixture of Dr Ross and Dr Rowlf, sometimes with tragic consequences. The recent scandal in Shrewsbury and Telford NHS Trust is a tragic example of the latter. A major review found mistakes at its hospitals led to babies being stillborn, dying after birth or being left badly brain damaged. Families were torn apart. Last year, there was a similar report into hospitals in Nottingham where more than 60 babies were gravely neglected with a similar outcome.

This is not to dismiss the value of the NHS, but to insert a balanced narrative often overrun with accusations of heroism or negligence. There is always a mixture.

An important part of economic theory paints precisely this more realistic picture, not just of NHS staff but of the public sector more generally.

James Buchanan was awarded the Nobel Prize in 1986 for his work in developing what is called “public choice theory”. It rejects the idea that public sector bureaucrats act in a disinterested, objective way; they are just as  selfish as the rest of us. Their primary motivation is not to serve the public, but to further their interests and those of the bureaucracy they are a part of.

The DVLA, based in Swansea, has become a notorious example, with its huge backlog of licence renewals. Most of the agency’s 6,200 staff were sent home during the first lockdown, but 3,400 of them were put on paid special leave without having to work at all.

No one has been sanctioned for this, and the chief executive remains firmly in place.

In a similar sort of vein, Public Health England (PHE) was so inefficient that it had to be closed down and rebranded as the Public Health Security Agency.

Its chief executive, Jenny Harries, built her career as a regional director of PHE. As Deputy Chief Medical Office during the pandemic, she was responsible for statements like the UK having a “perfectly adequate supply” of personal protective equipment.

Teaching unions didn’t fare well either during the pandemic, sometimes giving the impression their main aim was to ensure teachers were required to do as little work as possible while remaining on full pay.

Of course, examples of self-seeking and incompetence behaviour are found in both management and workers in the private sector as well.

But this is the whole point of public choice theory. There is nothing inherently more virtuous about the public sector, as much as we might like to believe.

For many, the coverage of the baby deaths were so scandalous because it was at the hands of a service often above reproach. Perhaps the scales are finally beginning to fall from our eyes.

As published in City AM Wednesday 13th April 2022
Paul Ormerod
Image: Flickr

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Alex O’Byrne, Associate at Volterra, is an experienced economic consultant specialising in economic, health and social impact, economic strategy, project appraisal and socio-economic planning matters.

Alex has led the socio-economic and health assessments of some of the most high profile developments across the UK, including Battersea Power Station, Olympia London, London Resort, MSG Sphere and Westfield. He has significant experience inputting to EIAs and s106 discussions as well as drafting economic statements, employment and skills strategies and affordable workspace strategies.

Alex is also experienced at economic appraisal for infrastructure. He was project manager of the economic appraisal for the City Centre to Mangere Light Rail in Auckland. He also led the economic and financial appraisals of the third tranche of the Transport Access Program for Transport for New South Wales, in which Alex developed and employed innovative methodological approaches to better capture benefits for individuals with reduced mobility.

He is interested in the limitations of current appraisal methodologies and ways of improving economic and health analysis to ensure it is accessible to as many people as possible. To this end, Alex recognises the importance of transparent and simple to understand analysis and ensuring all work is supported by a robust narrative.

Alex holds a BSc (Hons) in Economics from the University of Manchester and he was a member of the first cohort of the Mayor’s Infrastructure Young Professionals Panel.


Senior Partner

t: +44 020 8878 6333

Ellie is a partner at Volterra, specialising in the economic impact of developments and proposals, and manages many of the company’s projects on economic impact, regeneration, transport and development.

With thirteen years experience at Volterra delivering high quality projects to clients across the public and private sector, Ellie has expertise in developing methods of estimating economic impact where complex issues exist with regards to deadweight, displacement and additionality.

Ellie has significant experience in estimating the economic impact across all types of property development including residential, leisure, office and mixed use schemes.

Project management of recent high profile schemes include the luxury hotel London Peninsula, Battersea Power Station and the Nova scheme at London Victoria. Ellie has also led studies across the country estimating the economic and regeneration impact of proposed transport investments, including studies on HS2 and Crossrail.

Ellie holds a degree in Mathematics and Economics from the University of Cambridge.