NHS is beyond fixing

Given that the NHS operates as an oldfashioned state-run monolith, one would imagine that it at least has the structural capacity to implement improvements from the centre. Far from it. In an interview with this newspaper, Prof Sir Bruce Keogh, the service’s medical director, says that patients are being endangered by the lack of a central system for ordering changes to practice based upon safety concerns. The NHS might leak money like a monolith, but it operates like a “conglomerate of hundreds of organisations”.

A near record number of so-called “never events” were reported in the NHS last year, things that needn’t happen and shouldn’t happen, but do. There were 18 cases of an operation being carried out on the wrong knee. Surgical swabs were mislaid inside patients 22 times and three patients fell out of windows. And last month, the Care Quality Commission issued a report indicating that around a third of GP surgeries have put patients at risk. A man in a Brighton practice was found to be doing the work of a GP despite having no medical qualifications.

The Government has done its best to improve the NHS by, for example, imposing league tables of performance. It doesn’t help that the institution is at once enormous and unscalable, yet devolved and difficult to govern. Worse, it is protected by the myth that it is “our NHS” – a moral crusade – and thus this basic, flawed structure is beyond criticism. The sorry truth is that whatever is done to the NHS, more centralisation or less, nothing will ever really work. Other systems – Germany’s, Switzerland’s, Singapore’s – are better. Real change will only begin by admitting this fact.