Too many have been built or retained purely as a result of local political pressure rather than real need. The result is a duplication of services with a duplication of costs and a lowering of quality. It cannot and should not go on.
Of course when they're in opposition, politicians they won't say this. For them putting a rationale into resource allocation is the most wicked kind of rationing, hence the row today.
The cries go up - "cuts", "the NHS under siege" "14 days to save the NHS" and all the rest of it. How different it all is from behind the other side of the desk in Whitehall. Politicians, soon discover new priority, to make the capital devoted to the NHS work as hard as its staff. They don't have to go very far to find some examples.
Drive past any hospital on a Sunday and the doctors' car park will be empty. And not because the doctors have jogged to work! It is simply that most diagnostic equipment and operating theatres, the NHS' most valuable assets, don't operate before 8am or after 4.30pm.
If these assets were in the private sector, in a manufacturing plant, say, then they would work around the clock. But they seldom raise a sweat in the NHS. Despite the appearance that the NHS heaves, strains, pushes and pulls, it is simply demonstrating its inefficiency. The NHS, all to often, doesn't work. Not, that is, work in the sense that a Swiss watch or a computer chip does.
The NHS has always soaked up money without any real discipline about how it is spent. Efficiency and effectiveness have long been neglected - partly because of the political arguments that get in the way of rational debate.
Despite what Secretaries of State for Health say in the press and on TV, to reassure an incredulous public, there is an agenda to push hospitals together and close some down. Insiders in the NHS have known for months that regional offices of the NHS Executive have been pushing a formula known as "recon- figuration". This means merge, close, take wasteful capacity out of the system and drive the NHS to new levels of efficiency.
The big problem, as always, is public reaction. Close a hospital at your peril. The articulate middle classes will wage war from their sitting rooms, on their word processors, on e-mail while others will mob public consultation meetings and turn them to farce.
The politician fears to pursue the long term interest of the health service because of the fear that he will, like so many of his predecessors, watching his career disintegrate under charges that he is "uncaring".
Can Labour succeed where the Tories failed? They may have a chance. They have a new ally, a new type of doctor that they can use. Spin doctors may just be able to persuade the public that, in its 50th year, a year marked with especial enthusiasm by Labour, who claim paternity of the service, that the child has grown up and grown out of its old clothes.
It is a message that asks us to look at the bigger picture and face up to the the problem of resources. It is one that has to be put straight- forwardly. New Labour may just be able to persuade us the mergers and closures mean a new and a better NHS.
The writer is visiting Fellow at Imperial College Management School.Reuse content