ENOUGH is never enough for the NHS. So the news that recruiting 40,000 more nurses has failed to end shortages on some wards is not a huge surprise. For a start, the target for nurse recruitment was not very carefully calculated. It was a figure plucked from the air that was meant to look impressive and was achievable.

What matters to patients is not whether artificial targets have been met, but whether hospitals and general practices have the right nurses, in the right grades, doing the right jobs. The RCN surveys suggest that in that respect the Government has failed.

The NHS has been stuffed with junior nurses, almost entirely recruited from abroad, relies to the tune of more than half a billion pounds a year on agency nurses to fill the gaps, and still needs a fifth more nurses on the wards to achieve proper staffing levels. The problem is that while the Government can will the means, it cannot determine the ends. Ever since new money started flowing into the NHS, there have been complaints that it is disappearing without trace.

To answer these damaging criticisms, the Department of Health has produced two reports, one a rushed job by Sir Nigel Crisp, the NHS chief, and the second, slightly less rushed, by Richard Douglas, the Director of Finance. So desperate were ministers for good news before the rise in national insurance contributions that neither report could wait for properly audited figures.

Mr Douglas’s report, Delivering the NHS Plan, showed that in the 12 months from September 2001 the NHS employed 17,000 more nurses, 1,200 more consultants, 400 more GPs and 2,000 more therapists. During 2002-03, the NHS got an extra £5.2 billion, to bring spending up to £55 billion. About a third (£1.6 billion) went into pay increases, £1.3 billion into extra staff, £850 million into spending on increased drug bills and the rest on buildings, training and cost increases.

None of this is waste, but what nobody can know is whether the money was spent in the best way to improve the service. Only Adam Smith’s “invisible hand” — the market — can determine optimum use of resources, and the NHS is anything but a market. The all-too-visible hand of Alan Milburn, the Health Secretary, can set targets for hospitals, but a target hit in one place usually means a desirable objective missed elsewhere.

In addition, the NHS and its unions are dedicated to central pay bargaining, which means that less attractive nursing posts cannot be filled by the simple expedient of paying more. The growth of nursing agencies, is the consequence.

Meanwhile, the Government sets a new target: 80,000 more nurses by 2008, compared with 1997. Will that be enough? Almost certainly not, unless the freedoms to be enjoyed by foundation hospitals are by then extended to all. That might provide enough freedom of manoeuvre, in the teeth of opposition.

Explore UK News

• Crime News

• Education News

• Health News

• Science News

• Scotland News

Times Recommends

• An officer and a gentle woman
• Dame Helen Mirren is worthy of the Epidaurus
• Foods that can help to prevent swine flu