It is a medical maxim that diagnosis should come before treatment, so let's apply this to the NHS.
For many years politicians and the DoH have assumed that GPs are thick and lazy (always on the golf course, and incapable of spotting simple illnesses like meningitis); that consultants are intelligent and greedy (looking to their private practice rather than to NHS work); that nurses are sympathetic, reliable and conscientious; and that managers are needed to sort them all out, create a stable NHS and produce high standards.
These generalisations are often far from the truth. GPs are hard-working and overwhelmed by demand. Consultants often put in many more NHS hours than they are paid for. The popular image of the nurse is probably closest to reality, though specialist nurses usually don't have the wider abilities that lay people often imagine they possess.
And as for NHS managers ... some are good, but many are not. Medicine is one of the few industries where the front-line workers are often more intelligent and better informed than the people managing them: it makes for an explosive situation.
If politicians and managers try to solve problems using their 'imagined NHS' (lazy GPs, greedy consultants, managers as lion-tamers) then their solutions won't work in the real world. They can introduce as much money as they like, but if it mostly goes on lion-taming rather than lion food, not much will happen.
The real stresses on the NHS are large and are often inappropriate demands on primary care. There are too few resources for front-line staff; too many employees used inefficiently or in unproductive jobs; poor communication; inappropriate IT and the use of intrusive quick fixes.
Managers have forgotten their job is to facilitate the workers. Instead they think that constant interference will sort out the problems of healthcare delivery. Add to this politicians who are desperate for the NHS to succeed but don't realise that there's a difference between the true NHS and their imagined version and you have a recipe for failure.
- Dr Lancelot is a GP from Lancashire. Email him at GPcolumnists@haynet.com.