There have been some notable disasters, and the vast budgets involved have provided temptation and scope for some embarrassing embezzlement opportunities. And in many of these over-vast metropolis developments, it It takes 20 minutes to get from the (expensive) car park to the bedside. (If you can find a space at all).
Multiple smaller units also permit motivated staff to rise more quickly to positions of relative authority - whereas the career path in a hospitals of thousands has created a civil-service "so what" 9-5 mentality that is painfully obvious in most oversized trusts.
We all understand the benefits of organisations of any type where "everyone knows everyone". On the vast sites it is simply too easy for unauthorised people to wander in and out at will, and help themselves to equipment and staff valuables. Attempts to install security can severely impede normal operations as the "real" staff rush around and forget to carry all the right security devices with them at all times.
The new technology available should mean that administration is a breeze - but any government's record with IT projects are pathetic - unless they are something vital like a congestion charging scheme or speed camera network.
Computerised equipment like CT and MRI scanners should cost a fraction of what the NHS pays (just see how the cost of IT has fallen everywhere else) but there seems to be little effort to put the cartels of medical equipment providers on the spot to explain why a CT scanner still costs about the same today as it did 10 years ago. Suppliers will always point to a list of "enhancements" and new technology to justify the price, but the law of diminishing returns is severe in this type of gear, and 99% of all cases could be effectively dealt with by more basic models that could be operated by front line doctors and nurses, not rare and costly specialist staff.
An iPod is probably more complex and contains smarter technology than a 10 year old CT scanner.
Importantly, a lot of the operational responsibility could and should be devolved back to medical staff with admin assistants, and most of the managers who rejoice in holding meetings about meetings to create more work for themselves could go without any damage to the delivery of healthcare. The benefits to general morale of putting medical staff in overall charge of healthcare once again, would be huge.
The problem is that the turkeys will not vote for Christmas - so when consultants like McKinsey interview the management on cost savings we get bonkers propositions that preserve the nonsense hierarchy and instead seek to reduce front line staff.
So much of the shambles and waste stems from communictaion and record keeping - so the current NHS needs to be taken apart, and rebuilt around modern technology that extends to encompass the ever-growing needs for care in the home.
In such a process, there should also be an opportunity for the UK to create world-leading healthcare businesses - but the chances are that we will continue to bumble along with a world-class cockup. Sigh...
