I do, however, quite genuinely feel for anyone who has been asked to draw up plans to save £22bn. It isn't much fun being given an impossible task and then told to do it behind closed doors before explaining to the hospital's elected governors why they have been asked to give up so much of their time but aren't allowed to make any meaningful input to the process on behalf of the public.
There genuinely is a need to re-think the NHS. We have an ageing population and increasingly expensive treatments. Something significant does have to be done to manage costs and sometimes this does mean re-organising services. That is rarely popular and sometimes it can be justified for a decision maker to over-ride some serious unpopularity if the decision is genuinely in the best long term interests of the widest number of people.
But what is taking place in this re-organisation is not some cerebral piece of wisdom drawn up by very clever people trying to do the best. It is an attempt to fix a cash crisis by pretending it can be re-organised away. It is also an attempt to fix a problem in one part of the system which actually stems far more from two other parts.
In all the consumer satisfaction surveys the evidence is that what actually happens to patients when they are treated in an NHS hospital is widely approved of. My own personal experience also gels with this. If you can get yourself treated in an NHS hospital it is still the case that you are usually very well looked after.
The real problems come at the two ends of the service. Entry and exit. The General Practitioner service consists of a series of small and medium businesses that aren't owned by the taxpayer and aren't being run for the convenience of patients. Nor are they usually run in the way the doctors working in them would like. Doctors are put under immense pressure to form judgements about treatments on the basis of 15 minute phone calls and the doctors, nurses and sometimes even completely unqualified receptionists are forming triage judgement calls about who needs an appointment on the basis of a rushed phone call. The general public can't get an appointment with ease. In other words they have to wait for a date that is of convenience to the practice before they are allowed to be ill.
Not surprisingly when they get the short appointment the doctor rarely has time to do much more than send the patient away with pills. Even more alarmingly some doctors report being pressurised to make sure they offer the cheapest treatment because of practice budget pressures. It is not the case that all practice savings go back into the service. They can go in high wages and high profits to the practice owners. In the past you could have been pretty sure that those owners were the practice doctors that you saw regularly and who knew you and your history. Now the owners can have very different interests to the succession of different doctors who they employ to try and treat you.
The huge difficulties of getting seen and treated quickly locally by a GP are the prime reason why A&E is in crisis. We need a huge refocus on moving all minor cases of sprains, cuts and sudden flare ups of worrying conditions away from A&E and getting them dealt with instead by GP surgeries. Nurses at a GP surgery are quite capable of bandaging a broken toe and sending off to a fracture unit those that need something more. That would be cheaper, quicker, more local and could create the potential to safely offer fewer better A&E services where genuinely serious cases are dealt with. Obviously if more services and more money is directed to frontline GP services then the control over what GP practice owners do with that money needs seriously enhancing. But we can't leave GP practices to spend public money on offering a service that suits the practice managers but doesn't suit the patient. That does need re-organising.
At the other end of the health care service the problem is even more serious. When you enter hospital you fill out endless forms and are given careful briefings to make sure you understand what the hospital is going to do to you. This is also done to reduce the chances that you will sue. When you leave you get none of that. There is no systematic information about what happens next. Nor any real understanding that a very large number of patients are confused about this and really do need advice and guidance.
Even more worryingly it is often very clear to the hospital staff what is needed next. It just isn't available. Drug addiction treatment, mental health care, elderly care and transition support for those with who leave hospital with disabilities that are either temporary or permanent are all very hard to find. Local authority care funding has been cut and cut again at exactly the same time as the population has got more elderly. So the hospitals all too frequently can't discharge a patient with any dignity. The patient sits in a very expensive hospital bed because there is no care home place available and not enough money for care in their own home. All too frequently someone with serious mental or addiction problems is discharged only for them to come straight back in as a patient a few weeks later because their problem remains or has got worse and there is no place available on programmes designed to prevent this.
There is much talk about this care and health interface problem and even some attempts in Scotland and in Manchester to try and tackle it with integrated funding. There is simply no realistic understanding of the scale of the care funding challenge. You cannot have an increasingly elderly population, a pathetically weak care service and no crisis in the NHS. Or indeed in the wider community as people struggle to work out how to help their elderly parents often from many miles away without the family money to fill the gaps in the service.
So we do need a serious rethink and re-organisation of the service. Just not the one that is being imposed on us at the moment. And we do need to fix the problem that we have more and more elderly people and more and more expensive treatments for them. What we don't need is for that rethink to be undertaken by people who are collecting large consultancy payments for telling us that there must be cuts. We need an intelligent, well thought out properly financed plan.
Finally it is worth saying that there is one other helpful approach to our problems that could be pretty easily adopted. Increase immigration. If you have too many old people and not enough young people to pay for looking after them then it is usually wise to allow more immigration. Something the Conservative German Chancellor clearly understands but very few British Conservatives would dare say.
I wonder how many of the elderly people who would benefit from the help of more young active tax payers voted for that in the Brexit referendum? Or how many of the elderly realised that we are at severe risk of importing back to the country an extra half a million elderly people from places like Spain to clog the system up more completely. Whilst pushing out of the country a couple of million active tax-paying EU citizens? Or did they listen to the promises of £350 million a week for the NHS coming from the very same people who are now telling us the NHS has to be re-organised to save money?