The junior doctors’ strike is over for the moment as the row with the government runs on in the form of talks which may or may not get somewhere. Wherever they do get, even if it solves the dispute, is essentially the wrong place. This blog has said over and over, you cannot have an infinite service on a finite budget. The NHS is chronically underfunded at a time when demand and costs are rising. It has run by an overlapping structure of supervisory quangos, breathing down the necks of confused managers, trying to run a fragmented bureaucracy spinning out of control, through a command system with so many fingers in the pie or on the button that while it does not crash, neither does it deliver a timely healthcare programme. In an emergency it works, but for routines stuff, some of it life threatening, people are kept waiting weeks in a cruel system organised round the principle of waiting and delay.
To set the show back on the road envisaged by its founders requires 24/7 working 365 days per year. This would involve three 8 hour shifts for everybody, never more, operations at night and the elimination of waiting lists. It will also require a funding system that recognises the true cost has to be paid and that taxes will have to go up to meet it. If the public will not accept that, then the whole thing should be cut back to work within a finite budget and people who can afford it will have to pay for their treatment. The problem for politicians is that the public will not pay the higher taxes, but demand the universal free service. At least some savings could be made by abolishing the quangos, commissioning boards, foundation trusts et al and by returning to a rational management structure that derives its form from common sense, not Alice in Wonderland.