How so little improvement costs us so much

The NHS is approaching its 60th birthday and Lord Darzi is about to publish his review, so I thought I'd make a pre-emptive strike. What is the current state of the NHS, and how can it be improved?

The NHS currently costs £90 billion a year. For all the extra money, all that has been achieved over the past 11 years is a reduction in waiting times, a massive increase in bureaucracy, reduced availability of local hospital services and the huge and ongoing financial liability of PFI. Even with this colossal investment, the NHS survives only through the goodwill of its nurses and doctors who give considerably more of their time than they are actually paid for.

Any Martian visiting the UK would be appalled by its overblown management, the excess of regulations and the emphasis on financial efficiency rather than professional judgment. The creaming off of money for service management rather than for employing nurses or doctors has led to the inevitable: ward overcrowding; geriatric patients not being fed properly; epidemics of MRSA, C difficile and norovirus; too few front-line staff; and a training system which couldn't have been botched up more effectively if they'd tried. The computer system may well fail completely because it wasn't thought through properly at the beginning, and politicians are determined to wreck the one part of the NHS that actually works efficiently - primary care.

The NHS is being run as an insensitive command economy by managers and politicians whose focus is on the organisation rather than the patient. The list of failings above must be one of the most appalling indictments of any healthcare system, particularly in view of its exorbitant and ever-increasing cost. Tweaking the edges isn't the answer: the NHS needs dismembering and reassembling in a simpler, more professional and more efficient form.

To begin with, the NHS should be given back to the doctors and nurses: by and large we are the ones who get things right, while the politicians and managers - with some notable exceptions - get in the way. But how can we run a complex system like the NHS without hordes of managers? There is a way. More next week.

Dr Lancelot is a GP from Lancashire. Email him at

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