Health Secretary Jeremy Hunt is right: you don’t swap horses in midstream, least of all in a flood. The reshuffle has saddled him with a new burden but it is a step forward if it really integrates health and social care.
Meanwhile, we elderly have been warned: use your zimmer frame, keep warm, lay in a stock of medicines, nip early symptoms of a chill in the bud and for heaven’s sake stay out of hospital.
The NHS is facing its usual winter “crisis”. You might have thought something effective would have been done by now to prevent them from recurring year after year. It has been obvious for years that an ageing population and an exponential advance in medicine and surgery would place the NHS under increasing pressure.
Yet there is still no end in sight. Labour leader Jeremy Corbyn’s remedy – throw money at it – is clearly no answer, except perhaps as a short-term palliative.
It might therefore be useful to look at the factors which contribute to the condition of perhaps the most enlightened social reform of the 20th century. Judged by life expectancy, it has been a great success.
But the concept of medical care free at the point of delivery has consistently led to abuse. It had the NHS’s architect, Aneurin Bevan, bemoaning “the cascade of pills down the nation throat” soon after the NHS was introduced in 1948. From the outset it has been a bottomless pit, so that the poor are not driven away from necessary treatment by money they do not have.
The concept is noble but at what is becoming an unsustainable price. It is exacerbated by waste which is endemic in the public sector since public servants, however careful, are always freer with other people’s money than their own.
This takes me back to the 1980s when Margaret Thatcher discovered there was no effective control of NHS stocks. She brought in a Marks and Spencer’s manager to sort it out.
Whether he did so, I have never been clear, but I suspect that the intervention increased NHS bureaucracy.
Then there is our increasingly litigious society with ambulance-chasing lawyers doing their best to persuade patients to sue for damages for allegedly inadequate treatment.
This is quite plainly raiding the public purse. It has induced an ultra-cautious attitude throughout the NHS and, inevitably, more bureaucrats to shift reams of paperwork which rob medical staff of time for patients.
We have also seen abuse of the system with excessive salaries, generous redundancy and well-heeled posts for the recently retired. This is a scandal by no means confined to the NHS, but it suggests that top management is a law unto itself, regardless of its performance.
Then Tony Blair’s open door to immigrants has placed the NHS under much greater strain and cost. It is difficult to imagine how he failed to ask himself about the financial implications of his policy. It seems that ex-Chancellor Gordon Brown gave little thought to it when he sanctioned a new contract for GPs.
Finally, there are the patients themselves. As well as becoming more litigious, we are now a nation of demanding hypochondriacs.
This, of course, is not reflected in obesity or boozing yourself into a stupor at weekends. But just look at the tabloids. Their central pages are full of medical advice.
The consequences of all this vary from hospital to hospital and area to area, depending partly on the age profile of the population.
But the service’s plight and reputation are now such that urgent action is needed after years of tinkering. I do not pretend root and branch reform will be easy.
But let us never forget that the “free at the point of delivery ”concept went out of the window years ago.
After all, I pay my dentist, chiropodist and opticians’ bills and more than half of my outlay on carers.
We should certainly require drunks and drug addicts to pay the full whack of their treatment and put those with other lifestyle problems – obesity and smoking – on probation, as it were, with the prospect of some payment if they do not reform.
But the NHS needs far more than that. That is why it needs an authoritative examination. Jeremy Hunt should this day appoint a small but high-powered commission to analyse what is wrong and how to put it right, reporting by October.
We have to stop the drift. It costs lives. The NHS is supposed to save them.