Aneurin Bevan invented his increasingly murderous Stalinist monolith to generate payroll votes from the new health bureaucracy - a project that was always doomed to eventual failure, as has been shown. Now it's time to go back to first principles - what should a healthcare system, which is free at the point of delivery, look like?
For a start, it should have hospitals which treat patients speedily, and treats them well. The pre-NHS hospitals were run by county councils, municipal councils, and charities. But they were managed at arm's length - unless staff were allowing patients to suffer and die unnecessarily, day-to-day management was left in the iron fists of matrons and senior doctors, who had absolutely no time for the human rights of nurses who were too posh to wash, or junior doctors who left scalpels inside patients. Such staff were bullied into being more responsible, or sacked. We should return to this regime, and general hospitals should be put back into the ownership of local authorities - the democratic deficit is unsustainable. More specialist hospitals should be run by new charities, with board members chosen by the local authority, ex-patients, and specialist doctors' associations.
Both local authority and charitable hospitals should raise works finance by bond issues, not the outrageously expensive Public Fleecing Initiative, or PFI. Spot checks and sackings should be carried out by Department of Health hit squads, with criminal prosecutions and the imposition of "special measures" where appropriate.
Then we come to general practitioners and other primary care workers. They should work from their own privately owned premises, as they do now, only without taxpayer subsidies to maintain them. Their extensive form-filling duties should be scrapped completely and they should be paid on a simple per-patient, per year basis, with bonuses for old and disabled people, who naturally need more appointments. Practitioners should be able to set up shop anywhere, even in supermarkets. By limiting free at the point of delivery treatment to British citizens, the duration of appointments can be expanded to what it was before mass immigration and health tourism took root, prescription charges can fall, and dental payments can rise, so attracting more dentists back into public healthcare. Apart from the occasional Department of Health hit squad in response to a serious level of complaints, the state should butt out of primary practitioners' lives completely. They don't tell civil servants how to do their jobs, after all.
Who is going to pay for all this? You are, through taxation. But you will have the choice of where to get treatment, as the Blair government priced every single item of NHS care in existence - so the hospital you pick will merely claim back treatment costs from the Department of Health - whether the hospital is in the local or charitable public sector, or in the private sector. This is important - the ensuing competition will weed out the worst hospitals as their incomes plummet, and encourage the best to expand in order to meet increased demand. In this new consumer market driven system, there will be no room for quangos and specialist funding authorities. We will effectively have gone back to the system we had before 1948 - only without the need to take out health insurance, or to beg for free treatment from the hospital's somewhat patronising lady almoner if we cannot afford the premiums.
Just one more thing - if you are drunk and abusive to ambulance or casualty staff, then you will no longer have a human right to immediate medical attention in your cell at the police station. And if you die as a consequence of being so incarcerated, then your relatives can go whistle for compensation, for all the good it will do them.