How to solve a problem like the NHS?

If Sainsbury's meat counter killed 300 people, the firm wouldn't survive. Yet even in the wake of the Clostridium difficile scandal, politicians daren't insist on the radical reform the NHS desperately needs.

Florence Nightingale's Notes on Nursing, published in 1859, states that the "greater part of nursing consists in cleanliness", says Charles Moore in The Daily Telegraph. One hundred and fifty years on, for all our advances in education, technology, prosperity and science, this basic truth has been forgotten. Between 2004 and 2006, 90 patients in the three hospitals run by the Maidstone & Tunbridge Wells NHS Trust died from Clostridium difficile, and the disease contributed to the death of a further 241. This disease is an infection spread through spores in faecal matter: relatives of those who died reported that their loved ones were told to go in their beds' and were left lying in their own excrement. "Were it not for bad nursing, bad medical attention and bad administration, none of these patients need have died."

If Sainsbury's cold-meat counter killed 300 people, the firm wouldn't survive. Yet the NHS "sails on, dealing death", because we cling to the idea that a "single organisation employing 1.4 million people, with the GDP of an entire Scandinavian country, run by politicians, can meet our health needs". It can't. Under systems of social insurance, as in France and Belgium, problems remain, but there is "no danger that any patient will be treated as a nuisance" and hospitals are spotless. Money follows patients, who choose who treats them so every doctor and nurse wants patients.

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