I saw first-hand the awful waste in the NHS

More money will not cure an inefficient service ill-equipped for an ageing and unfit population

No,” said the registrar. “I’m afraid you can’t keep having MRIS.” It was nearly seven years after I had first found a lump in my breast and I was about to be discharged. Please, I said. That first tumour, I explained, had been invisible on the mammogram, so how could I be confident that future mammograms would reveal anything? The registrar said he would ask the consultant. Three weeks later, I had an MRI and was told that the cancer had come back.

MRIS are expensive. According to the rules, I was not allowed one, and I am not allowed them now. Rules are there to keep costs down. There are 65 million people in this country and if we’re going to carry on letting all of us use the NHS we are going to have to make savings somewhere. I was lucky. Fifteen years after I first got cancer, I’m still here. But if we’re going to keep a lid on costs, some of us are going to have to die before our time.

Research by the Institute for Fiscal Studies and the Health Foundation shows that every household would need to pay £2,000 extra a year just to keep the NHS ticking along as it is now. People are living longer, but older people cost more. By 2033, says the report, there will be 4.4 million more people in the UK over the age of 65. Spending will have to rise by 3.3 per cent a year if those people want a service anything like what’s on offer now.

To get there, we will need to cut waste. And anyone who uses the NHS as much as I have will see plenty of waste. In my first year of cancer treatment, for example, there were the letters for appointments that arrived after the appointments. There were the pathology reports that took six weeks to travel 25 miles. There was the mammogram that turned out to be the X-ray of an ankle. I never did find out if the ankle was mine.

This was in 2003. Labour had doubled spending on the NHS. If you think more money automatically makes things more efficient you would, I’m afraid, be wrong.

Everyone thinks they can sort it out. New governments come in, promising bonfires of quangos, and reform. David Cameron promised “no more topdown reorganisations” of the NHS and then introduced the biggest in its history. Management consultants are brought in to clear up the mess. A report published in February by Bristol University showed they were costing more than they saved.

There are things that can be done, if you have the courage to do them. Ten per cent of appointments are missed. That costs the NHS about £1billion a year. Would it really be so bad to charge people for not turning up? Seventy-one per cent of us, according to a new poll by Ipsos Mori, seem to think that a small fine would focus minds. A fiver, perhaps. You know, the cost of a glass of wine.

Procurement varies wildly, with some trusts paying 13 times as much as others for basic equipment. IT is better than it was, but there are often big glitches when contracts change. Email is still seen as far too modern for patients. Printed letters still get lost.

But the much, much bigger issue is that the NHS was designed for acute diseases, and different times. Our big problems now are that we’re old, we don’t move much and we’re fat. We have “complex co-morbidities”. We want to go to a hospital and be given a pill. We want, in fact, to shut the stable door after the horse has bolted.

There are different approaches that work better. These start at the community level, and don’t just tackle people’s medical needs. At the Bromley by Bow Centre in East London, along with a walk-in centre and GP surgery people can access sports and social activities and legal advice.

In Cornwall, a couple of years ago, I spent a day at a project that was a collaboration between Age UK, a GP surgery and a community nurse. The project cut emergency hospital admissions by a third, but the funding was axed.

Of course, we can’t just shut down hospitals, but we need less of a focus on disease and more of a focus on health. We need, in other words, less “top down” and more of what you might call bottom up. Perhaps what we also need is doctors who will listen to their patients and know when it’s right to break a rule.