It's. Too. Big.

This time it is the Conservatives stealing an Labour policy. It won't work for them either. Patricia Hewitt is right on this one, the NHS is simply too big to be manageable. Handing it over to an independent board (and how independent they will be in practice is still anybody's guess) will not change that. The inertia of the huge bureaucracy of the NHS will still resist all attempts at change while sponging up any extra cash that becomes available so it never reaches the clinical professionals.

There are economies of scale, but there are also diseconomies of scale as the hierarchies of bureaucracy grow, and so efficiency against size forms a curve[2]. This happens in all organisations whether public or private. Any organisation as big as the NHS would be inefficient and there is absolutely nothing going to change that unless they also do something about dividing it up into more manageable sized chunks. Maybe still as a state run system, but run by local government as in Sweden. Perhaps a multi-payer/multi-provider system as in France[4] where the hospitals are all independent organisations and the state just provides a basic universal insurance. Or if you want to be radical get the state out entirely and just have it recognise that because some things are important they should not be taxed as in the Singapore system for healthcare. It is the NHS's obesity that is killing it. The crisises might individually be dealt with, but unless the root cause is too then they will just come back.