A common criticism of politicians is that many of them have never worked in the ‘real world.’ The secretary of state for education has never been a teacher, the secretary of state for health has never worked in the NHS, and so the list goes on.
Somebody not having worked in an industry directly in the past does not mean, of course, that they cannot offer valuable ideas – that would be a very foolish thing to suggest. However, there are certain insights that can only possibly be gleaned from working within the machine itself. Being part of the system.
As somebody who has five years’ experience running a small business, for example, it is patently clear that gaps – no, gaping holes – exist in HMRC’s system, which actually put domestic businesses at a disadvantage versus those operating outside of Europe. Chinese businesses, in particular, are notortious for underdeclaring or wholly misdeclaring on customs paperwork. By law, any import from outside of the EU is subject to 20% import VAT, but when the seller is willing to declare a $100 item at $2 and it goes unchecked by HMRC, Chinese sellers have an instant 20% price advantage over all but the very tiniest of UK businesses, who don’t have the luxury of not charging VAT to their customers. This makes the medical device market fiercely competitive, from small devices like pulse oximeters, to sophisticated ultrasound equipment, with many buyers willing to take a gamble when it comes to lack of technical support or backup in exchange for a hefty discount.
As difficult as it would be to do, closing this loophole would bring in millions of pounds in revenue for HMRC, in collected VAT and/or in VAT and tax from UK businesses, to whom much of the business would surely shift. Besides the unfair advantage issue, there’s also the other ethical issue of the quality of much of these imports. Ultrasound equipment, in particular, is subject to huge variability in its quality and safety standards, and from human bladder scanners to canine pregnancy ultrasound, the quality of the equipment being sold online means that it’s only a matter of time before the safety record of this diagnostic imaging modality is irrevocably harmed.
Yet, none of those who actually have the power to do anything about this situation, have any working knowledge of it at all.
Sticking with the healthcare theme, another example is the NHS. One of the most precious institutions of the United Kingdom, the fact that it is captained by people who have never worked a day within it means that the things which look great on paper rarely works in practice. The outsorcing of portering to private firms causes huge inefficiencies, as departments sometimes wait upwards of half an hour for a patient to be brought down for their test – not to mention the discomfort caused to an elderly patient who then has to sit cold, tired and bored in a wheelchair in the corridor waiting for a porter to show up to bring her back to the ward.
Of even greater concern is the proliferation of locuming across the UK. Heads of department and even experienced consultants are leaving their positions, only to be placed back in the same job by a locum agency, receiving double the salary (with a cost to the NHS of triple, given the agency’s commission), with far less responsibility. As well as the direct financial costs, the quality of care is severely impacted when departments are no longer made up of permanent staff. No investment is made in training a department which, on paper, hardly exists (because it’s made up of agency staff, not people employed by the hospital). There is no spare time available to hold departmental meetings and ensure that all staff are adhering to the same best practices. For diagnostic tests like echocardiograms, where reproducability between operators is crucial to the reliability of the test, this renders the examination at best inefficient, and at worst dangerous.