No one has the balls to fix the NHS

I see the NHS is in the news again this morning as a result of a no-brainer report which says if you want to save £20bn of NHS spending then you're going to have to cut some jobs. The report, which one presumes was paid for by the taxpayer, has been dismissed out of hand by the Government. This is because it is not politically acceptable. No matter if it might in fact be right of course.

To be honest, the way in which it has been dismissed, and I expect it will be dismissed by the Tories as well, perfectly illustrates the biggest single problem that the NHS has. It is driven by producer interests, not patient interest. Of course, there are many that would reject that, but it is the sad truth.

The structure of the NHS, which means that the Government own the hospitals and employ the staff, means that no amount of sanity will ever prevail when it comes to assessing headcount. It is just like the problem of MPs salaries. MPs won't shout for more money because they can't politically do so. Likewise, saying you want to cut some NHS jobs - however useful or otherwise the jobs maybe - is a complete no no.

Everyone talks about reform of course but the reality is that you will never be able to reform it because it's a monster. It is an anachronistic structure out of place with the contemporary reality of Britain. However, and to quote Blair, the "forces of conservatism" in Downing Street, the Department of Health and the wider Left will never let it be changed.

Likewise, the "forces of political fear" on the Right in CCHQ will never really let it be properly addressed in a radical way. It will be tinkered with on the margins instead. More money here; less money there. More staff thrown in for something; no redundancies only restructure.

There is this myth that the general public "love" the NHS. Actually, what they love is the universal nature of its service, they couldn't care less about the structure that delivers that to them. Sadly though, no one has the balls to get serious. Ideology or political fear rules the day, and it will continue to do so for many years to come.