PJ O’Rourke, the American satirist who died this week, reflected that there are four ways to spend money:

“If you spend your own money on yourself, you are concerned about both value for money and quality. If you spend your own money on someone else, you are concerned about value for money, but less about whether it is suitable. This is why children get socks for Christmas. If you spend other people’s money on yourself, you are still concerned to get good stuff, but the price no longer matters. And if you spend other people’s money on other people…that’s the Government.”

Next year the state is due to spend £4.18p for each £10 that we earn. We can do what we like with the other £5.82. The Government’s current plans have the state share of spending going up a notch to 41.9 per cent of GDP the following year. Yet a week ago, Steve Barclay MP,  the Chancellor of the Duchy of Lancaster and Chief of Staff at No 10 Downing Street, wrote that “it is a priority to restore a smaller state.”

Oliver Dowden, the Conservative Party Chairman, gave a speech this week to the Heritage Foundation, denouncing woke ideology as a “dangerous form of decadence”:

“This ideology is now everywhere. It’s in our universities but also, in our schools. In government bodies…”

Perceptive readers will have spotted the flaw. It is under a Conservative Government that we are seeing our liberty diminished by the state spending more of our money, while our freedom of expression is eroded by the imposition of groupthink.

So while statements from Ministers endorsing Conservative principles are a welcome start, the clamour is growing for the reality to match such aspirations.  Let us consider, for instance, an NHS Quango called Health Education England. The Mail on Sunday reports:

“Andrew Scarborough, 36, who is mixed race, fears the obsession of his employer NHS Health Education England (HEE) with politically correct causes such as ‘white privilege’ and ‘toxic positivity’ distracts workers from doing their jobs. The project support administrator – who is still being asked to work from home along with his colleagues, despite the Government urging people to return to their desks – said he found it increasingly difficult to carry out his duties due to the barrage of woke emails and bulletins received almost daily from his bosses. When he queried the quango’s ‘political’ messaging, he claims he was reprimanded and called a racist. He decided to speak out when HEE, which gets £4 billion of taxpayer cash each year to support NHS training and skills development, invited staff to a virtual ‘white privilege’ course to address ‘unconscious bias’ and ‘white fragility’.”

£4 billion? Surely the journalist must have made a mistake and this ludicrous and obscure outfit gets £4 million? But no. Though the latest HEE annual report does have plenty of impenetrable jargon. But the figure for the money it gets from us is pretty clear. £4.3 billion. It has 2,432 staff. 15 of them are paid to be full time trade union officials. The Chief Executive was reported to be on £225,000 a year. The Chief Operating Officer did even better on £235,000. The Director of Corporate Accountability and Engagement earned £150,000. The Director of Innovation and Transformation got by on £135,000.

But what do they all do? That’s when it gets a bit fuzzy:

“Our vision is to help improve the quality of life and health and care services for the people of England by ensuring the workforce of today and tomorrow has the right skills, values and behaviours, in the right numbers, at the right time and in the right place.”

The money goes on training. But is it of practical benefit? An initial medical degree takes four years. But the medical schools get most of the funds for that from tuition fees and from the Office of Students. (The OfS distributes £1.4 billion a year to help with “high cost” courses.) The HEE swings into action for the later stage. An apprenticeship for trainee doctors and nurses to be embedded with experienced professionals in hospitals is, of course, of great importance. Some of that £4.3 billion goes to hospitals willing to take the time to show the ropes to these keen new recruits.

But how much goes on taking doctors and nurses, young and old, away from the wards and off to hotels for conferences on “toxic positivity”?

Even when the funding is for something worthwhile there are concerns about the lack of accountability. A report from the Reform think tank highlighted a lack of transparency. But it also suggests a wide variation in the spending per placements. There have been complaints that NHS Trusts have not been clear about what training they provide for the money.

Probably the HEE should be abolished. The training funds could be devolved to the NHS Trusts to make an offer to student doctors and nurses; perhaps that if they worked once fully qualified for a number of years their cost would be written off but otherwise would need to be reimbursed. Or the medical student could be issued with a voucher to provide a reward for hospitals offering an internship. Some kind of internal market of that kind would surely be an improvement on the current arrangements. It would also offer a financial constraint on all the extraneous woke absurdities.

Perhaps the HEE should continue, but be scaled back so that its only spending was of practical benefit to patient care.

But it is obvious that the £4.3 billion of our money currently being spent by the HEE is not justified. It represents over a third of the planned £12 billion increase in National Insurance. Sajid Javid, the Health Secretary, is fond of repeating the mantra that “every penny spent on the NHS must be spent wisely and in the very best interests of taxpayers.” Now he and his colleagues need to do some work on giving these claims credibility.


It has been pointed out to me that some reform proposals have already been announced. The Department of Health and Social Care states:

“The Health and Social Care Secretary, Sajid Javid, is also setting out his intention to merge the body responsible for the education and training of the health workforce, Health Education England (HEE), with NHSE/I, putting long-term planning and strategy for healthcare staff recruitment and retention at the forefront of the national NHS agenda.”