The NHS is not a religion it is one of Europe’s largest employers and one of its biggest enterprises. As such it demands the highest standards of management, not least financial management. The welfare model is robust – healthcare funded out of general taxation with the sick not being penalised if they are poor. But as taxpayers it is reasonable for us to ask that the Service is run efficiently.

Efficiency is about standards and about meeting those standards at least cost.  You cannot talk about the “NHS Budget” without simultaneously talking about what it delivers. For example, what is the target waiting time for operations where the patient’s condition is not life-threatening?  How long should a patient have to wait in A&E before being seen. What are criteria for prescriptions if the medication is of very high cost?

There are judgment calls along the way. To facilitate decision-making openness is essential. Here subsidiarity – taking a decision at the lowest practicable level – is important. It seems logical that this be at the patient’s interface with their GP. Larger GP practices and/or grouping of GPs together so that they become much wider in the scope of what they do should be the norm. If each GP has a speciality that could ensure that a patient’s symptoms get early attention rather than delay from referral to a hospital or specialist.

Healthcare is often described in ideological terms. The Free Market versus socialised medical services. This will always be unhelpful. There is no better example of the mixed economy than the NHS. The State working had in hand with the private sector to deliver an efficient and integrated service. Obviously on the margin decisions need to be made about whether an activity should be contracted out rather than carried out by NHS employees. Again, standards and efficiency are paramount. Expressed perhaps over-simply one can say that the standards need to be agreed and then decisions made about the best way to meet those standards and the appropriate mix of public and private sector staff involved.   

Costly though it is the NHS compares favourably with other countries. Of the G7 group of large, developed economies, UK healthcare spending per person (£2,989 in 2017) was the second lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736). Obviously, this does not necessarily compare like with like and the delivered standards may not be comparable. But it is a myth that the British system is profligate.

A debate on Healthcare is welcome not least because it is clear what we do now is sub-optimum. We may need to spend more; we certainly need to spend better. What we don’t need is to make the Health Service a battleground and ideology wars.

The Times has a good leader today under the above headline. But elsewhere there are strident calls for pupils to return to school and for restrictions to be relaxed. Do we learn nothing at all ? We are where we are because of a populist driven desire on the part of our Government to relax restrictions, and not impose others that were necessary, last year. The deadly “Boris Saves Christmas” nonsense killed thousands, for example.

The emphasis should not be on idle speculation on the timing of the relaxation of rules but on how we stop killing people at one of the highest rates in the world. With the vaccination programme a start has been made but new mutations and variants seem to occur every day. This pandemic is still running wild.

The more some politicians and media drivel on about COVID-19 threat to the economy and to our children’s schooling the more public opinion shifts away from the real issue. To get on top of the virus once and for all. Only when the risks are minimised should we consider relaxing lockdown.

Leadership should not be about doing what is popular but what is right. We are a long way from any sort of normality let alone a significant one. Courageous journalists and politicians won’t play to the crowds but tell it as it is. If we could find any.

Danny Finklestein has a fair and informed report on Britain’s Vaccination success in The Times today. But for me with one worrying exception.

I had my first Pfizer vaccine on Monday and all seems to be well. I was given a card with the date of the vaccination but a blank where the date of the second will eventually be filled in. When? No idea.

What is clear is that my second jab will be many weeks later than Pfizer recommend. And that Britain is the only country ignoring the manufacturers’ recommendations. Is there a chance that the whole effectiveness of the vaccination campaign will be damaged by the Government decision to delay?

I hope I’m wrong and I stand to be corrected but on the face of it the long gap between jabs seems to be a political not a medical decision. Ironically, as Libby Purves points out in the comments section of Finkelstein’s piece, Kate Bingham in charge of the vaccination programme has an appropriate background in bioscience and pharmaceuticals. Surely her contacts among the specialists will have told her what the manufacturers’s advice was. Did she choose to ignore it? Or is there something we don’t know ?

Rachel Sylvester in The Times today writes about mutinous Tories. If only, if only. The “One Nation” Tories of yore were purged prior to the 2019 General Election and any other MPs who exhibit one nation tendencies risk finding a horse’s head in their beds. Suggest that Brexit may be other than strategic genius and you’d be well advised keep well away from the boating lake.

The only actions that put Johnson under pressure come from the libertarian Hard Right. He has responded positively to this mob frequently over COVID – for example at Christmas when the irresponsible and deadly relaxation of rules – “Boris Saves Christmas” – has clearly killed people who would otherwise still be with us.

The people who took us out of the EU, who want to emasculate the BBC who want to remove regulations are the antithesis of the Old Conservative Party. All of them indulge in Thatcher worship even though some of the nationalist and faux-patriotic claptrap they spout even the great she-Elephant would not have countenanced.

With the fall of Trump (Dea Gratia) Johnson is the most significant world politician flying the flag of the provocative Right pushed all the time by the ERG/CRG in his own party. He does, eventually, what they want. In Turkey and Poland there are others on this track and Ms Le Pen is threatening in France. Dangerous times ahead.

Johnson is no more a traditional Conservative leader than Trump was a traditional Republican one. In America virtually all of the Republican Party stood by Trump to the bitter end. Same here. Johnson is manifestly inadequate at anything but the “Ra Ra” self promotion bits of his job. “Make Britain Great Again”. Populism in Power. But he’s safe.

In his inaugural speech Joe Biden asked for the return of truth to politics. Trump’s lies had brought divided America close to failed nation status. Here the core of our Government’s inadequacy is their unbelievability. Combine this with their manifest incompetence and you have a country so far down the slope towards failure it looks irreversible.