The UK media frequently blazes the headline above as it it were a fact. But is this true? Does the sheer scale of the NHS make it a bastion to attack? A fortress? My local hospital complex in Dundee, Scotland, is vast and expanding rapidly with new building being added, new and more vast car parks and research centres as well as other medical facilities. It is a site which could fairly be compared though dwarfed by Texas Medical City in Houston. Is this the way that we are going in medicine, ever bigger and better? Hospital after hospital as an economy of scale but pure hell to access for staff and patients. This ought not to be the norm, should it? Or can we call a halt to this type of modern industrial complexity in health care? Ought community hospitals built to serve their locality be what we should demand for our politicians and planners? Anything rather than monster campuses surrounding a medical university.
The NHS. Too big to fail?: The UK media... - Lung Conditions C...
The NHS. Too big to fail?
In my opinion no big business (which the NHS is) is infallible. You get to a point that you are top heavy with management and can't sustain growth on a roots level. It was explained to me as being like a pyramid with the base (the workers) supporting all the levels (management) way up to the pinnacle of a CEO. With to much management in place the pyramid is turned upside down and bound to collapse at some point. So no the NHS is not to big to fail. Just my opinion. 😒
Good points Dave_H.
Like the proverbial iceberg where most is under the waterline, layers of management are obscured in our big hospitals, and their effects on health care. Successive governments choose to prop up the system status quo, so empires are built accordingly with their own ideologies and management- think, where Big Is Beautiful, so large and impregnable that I can't see the NHS collapsing under its own weight, if that is what you were implying. Maybe I stand to be corrected on this Dave, but if any "collapse" event occurred, the impact would be catastrophic. Not just for CEOs and their ilk but for all of us.
I wonder if all this is 'deliberate' and is paving the way to an insurance based system like in the USA and other countries. God help us if it is! x
Yes hypercat54, I have wondered the same.
At risk of going off point here, I find that the marketability of the health care system in the USA can lead to the commodification of life to its commercial value. Anything can be described as commodified if it is measured in market terms. So, hypothetically. both patients and nurses or other clinicians, are for sale within the market of health care. This could change human value or how we are all valued fundamentally. This is a big claim, and I am conscious that it is highly contentious, perhaps a step too far for some of the readers of this HH forum. I shall leave you to be the judge of that. We may be in need of some sort of intervention, not necessarily supernatural, but economic all the same.
Did you read Apeter’s recent post? Things are grim in the NHS but at least no one in this country has to make the choice between bankruptcy and possibly important medical tests. (Hope it’s ok to refer to that).
I think I mostly approve of these large university hospitals- it’s where we should find best practice and the latest advances. However there is the Glasgow one (can’t remember its new name, the old Southern General), locally christened the Death Star.....Glaswegian black humour....which has had all sorts of problems with its children’s wing. The days of local cottage hospitals are long gone and although now we might never see the same doctor twice we can only hope they have at least read our notes!
My son was treated in the neurosurgical dept in Aberdeen, the necessary expertise wasn’t available in Inverness. We can’t expect to have every specialty just round the corner and I accept that.
I see where you're coming from Cateran, but look at A&E in any hospital, they are not coping. Most hospitals are now struggling to get the best doctors and nurses because private medicine pays more. I don't know how it will end but, I'm not optimistic.
My problem is with communication between surgery and pharmacy. Last Thursday I rang my pharmacy to request a repeat prescription. There were 13 items on it, so not all my meds were requested. The following Monday one of the items was delivered and I waited for the rest to follow later that week. Yesterday (1 week and 1 day after putting in the request) They still hadn't arrived. I rang pharmacy to be told they hadn't returned from GP and could I ring GP to to find out what had gone wrong. So I rang GP and receptionist asked which items were missing. When I read the list out she said "These haven't been ordered" and offered to get the list to the GP and I should get them next week. Pharmacist doesn't open on Saturday. Then I rang pharmacy again to tell them what I'd been told. She said "If we ordered the one item that had been delivered, they would have ordered them all. So somebody's lying, I wonder who. As I'm housebound I need to be able to trust people but that trust is being eroded.
I also have experienced this problem from my pharmacist, and you can see the circularity of the problem. You are d.... if you do and d...if you don't, It's all mind bending, as if the system exists in a parallel universe and you are just a mere human who does not belong there. You could compose a poem about it...nonsense verse!
Oh don't give me ideas Cat. 
I would think after 71 years the NHS is a victim of it’s own success.
Difficult one this Terry - large centres of exvellence within large hospitals, normally within large cities, serving huge areas but with the latest and best equipment and expertise to treat - small local hospitals beloved by generations, and where many of the patients and their forebears were born, now having to travel many miles but less money for difficult conditions and expertise and equipment.
I attend a large hospital where you seem to sometimes have to walk miles but when I go to outpatients it is held in the small hospital which used to be my second home. You only have to walk 3 clinics in. There is no pharmacy but there is an xray department. It’s old but easy.
My main concern is the gradual privatisation, with privately employed staff in NHS uniforms. I feel this will become much worse, even though they say the NHS is not for sale - there are ‘folks’ just waiting to get their hands on it and I fear the insurance system.
Cx
The essence of which you comment cofdrop is in the reference to creeping privatisation and its sister the insurance industry. I believe that the privatisation poses a huge theoretical problem because its result is to "privatise" us, the patients, as well as nurses, turning us into commodities in the market place, hence the creeping insurance systems which will help to rationalise that eventuality for politicians and health managers. We become commodified,as if we were things, goods, part of an exchange system.
So your concern is justified cofdrop, in my opinion. Sorry to wedge in this economic interpretation within my perspective but it follows on from what I have thought about over the years as a patient. My own child and grandchildren are part of the Australian system of health care, which as you know, is an amalgam of market forces and of private insurance.
You do paint an attractive picture of your own "cottage" hospital, which is the ideal in some respects, as you are the ideal patient, a person I can easily relate to. Which I fail to do with the current NHS and its monolithic nature, as skischool points out below.
Aat the same time as painting the old hospital attractive Terry, it wouldn’t be if it weren’t for the amazing staff who’s base is in one of our huge centres of expertise hospitals within the city. I am lucky that I live within the city, but just to take our CF centre, the specialist nurses visit patients within the West Yorkshire, North Yorksire and Lincolnshire regions, If it were the typical ‘cottage hospital’ I believe they would be completely out of their depth to deal appropriately with such a complex condition/patient. They did a good job during childhood but that was mainly because a/ there wasn’t much else around by way of treatment and b/ there were no specialist paediatric lung consultants but I was lucky enough to be under the care of a very enlightened and the first paediatrician at the start of the NHS.
Love cx
Unfortunately we can't expect our small community hospitals to cover the range of conditions that are presented to them on a daily basis from a population of nearly 68 million people who have been led to expect treatment from the cradle to the grave and just the economics of this dictate that these huge,often cold and soulless monoliths of health care know as centres of excellence would appear to be the norm for the foreseeable future?
We would all love to return to the good old days of community hospitals,employing local people with doctors and consultants perhaps even born within that community but that would only really work somewhere with a much smaller population.
I cannot fault your analysis, skischool, which is insightful. I wish I had thought to use words like you do to communicate the reality of the NHS as it has become, perhaps out of control, would you say? By all means centres of excellence for research and development. Can we the public claim ownership though? The market is hovering in the USA and elsewhere.
I was thinking more like these centres of excellence will provide the best possible treatments and care available,especially for the more complex and demanding conditions.
Alas the private sector will seek to gain access and control of these centres as they are a honey pot for their shareholders and those who wish to capitalize on our own poor health and it is then up to us as a nation to try to resist them in the best way we see possible.Are we prepared to pay the price though in terms of costing.i do hope so and would be prepared to pay more taxes if that was the means of doing so?
I wouldn’t want to return to the small community hospitals Skis for complex conditions. We are very well served by a number of hospitals (centres of excellence) but I apprecate it must be difficult to travel for many people but they are prepared to do so to get the best treatment which is not available where they live.
Cx
I entirely agree Cof,we can't expect our corner shop hospitals to specialise in anything other than the good quality standard care and emergency services we require and there needs to be more care in the community as well to lighten their load. 
x
A couple of years after I had to retire, Virgin bought up the Community Rehab. Team I had worked in. At least 2 very good members of staff took early retirement as they could not cope with the methods used to rationalise the amount of care given to individual patients. That being said, when the NHS was started they could have had no idea what would be possible in terms of treatment, nor its cost. There needs to be a proper discussion between the government and the tax payers, as to what we can/will fund and what we will not. We do need the large centres of excellence, for top class research. However the buildings can be done, in such a way as to mimic, small specific areas, to allow us patients to manage our way round them.
As to being "too big to fail" anyone here remember when that was said about Leeds United? Late 1980's I think.
I will only mention Scottish hospitals as I cant comment about others but ours are failing patients badly in all regions of Scotland.
When I worked at the Elizbeth Garret Anderson hospital in the 1980s, it had two hospital administrators, with payroll done by UCH. Then in the 1990s the financial system of each hospital department invoicing another hospital department came in, and the administration departments mushroomed. I remember being marked down for criticising the new system when in my final year of dietitian school. I retired earlier than needed because the weight of continuing professional development work required of me was more than my part time hours each week and cost more than I earned. I feel as if people who have not experienced working at the 'coalface' of the NHS are making arbitrary decisions about what they think will make things better, without test-running their proposals first. Hence the problem with pension limits making doctors retire.
I often felt that the changes themselves were irrelevant except for the fact that each time the Admins increased and new headed notepaper was introduced, with the thousands already done being junked. For me the main problem was the frequency of the changes, I never had time to cope with the change in my required practice, before another was introduced. Patients never seemed to be part of the equation from management or government's point of view.
It could be SORREL that the rate of change, the pace and dynamic of alteration, are proportional to the urge for constant development in the NHS. Develop or die might be the unconscious mantra of the bureaucracy, which must renew itself and self-perpetuate the system in order for it to run on its own and consume resources, including human commodities and goods, as well as paper and departments ruthlessly merged or re-named. Here is the market in action, endless consumption, regurgitated as so much waste of built-in obsolescence. As Ergendi implied in her (?) post, the whole process can appear arbitrary and untested.
The big day 
The Damp Patch.
Who doesn't blame our politicians for the problems within the NHS?
COPD, NICE, the NHS and US!
