Just to kick off, here's what I'm not going to do. Actually, let's rework that: here's what I'm not going to do within the context of the things my chosen title might have made you think I was going to do. I'm not going to make this a political rant. I'm not going to tell you all about the state of the NHS, either that it is in dire straits or that it is much better than everyone says. God knows I'm not about to try and explain how to fund the NHS. I'm just going to tell you what, in my not-remotely-humble opinion, it should be, and then invite you all to agree with me.

Let's start the fiscal ethos then, shall we? It has, for many years, been the thinking of successive Governments that the public sector¹ would be better served by being run along private sector lines. This is wrong. The principle of a business is to provide the worst service or product it can get away with and charge the largest amount of money it can persuade people to part with in exchange. That may sound a trifle severe, and of course not all businesses extend that logic to its ruthless conclusion, but that is fundamentally where the profit margin lies. You need to spend as little as possible on the thing you are selling and try to get maximum revenue in return. If you can't earn more than you can spend then you are pretty soon out of business, and that is no way to run a hospital.

Business is guided towards profit because that is the point of a business, but that isn't the point of a hospital. As such, the finances should be bent around the real function of the hospital, not the other way around. Just to be clear, the point of a hospital, and of the NHS more generally, is to make people well. We have moved, and rightly so, into an era where this is not a purely interventionist strategy. Rather than simply waiting until people get sick/injured and then trying to make them better, there are increasing moves to educate people to look after themselves and hold off the extent of sickness and injury. People are, at times, wont to complain of the 'nanny state' for things like restrictions on cigarettes and alcohol, and complain that we don't need to be told how to look after ourselves, but we do. It's not that we're ignorant (not all of us – some of us are morons) but medicine is a hugely complex thing and most of us (I'm including me in this) simply don't have the knowledge or understanding to make informed decisions, so we do need guidance from people who know.

But first and foremost the NHS remains an institution to fix us when we are broken. One of the finest principles is 'free at the point of delivery'² but sadly that has been eroded. You now pay (albeit subsidised) for prescriptions and dental treatment and opticians. Now I know I am living in a dreamland imagining that the demands I am already making on our health service can be fully funded as well as paying for all this stuff that wasn't being paid for in the first place, and I probably am. What we have to consider, though, is the potential for investing so massively in an initial NHS budget that the long term costs go down because the populace as a whole is in a better condition. I know, perhaps unlikely, but worth a thought, and anyway this is an aspiration, not a manifesto.

And so to the final arm of my multi-limbed medicinal leviathan. Holistic care. Wait, wait, come back. Don't stop reading. I have no idea what holistic healing actually means and I know that it isn't scientifically supported, but that's not really what I'm on about. My first suffers from one of a plethora of conditions which affect the whole body, and for any one specialist to understand the full impact of their bit, they need to be able to see the bigger picture. That your podiatrist can consult your physiotherapist and your ENT consultant can refer you for scans that send you to oncology means that, relatively speaking, you should be pinged around the system with comparative speed, and relevant data about your health shared between professionals in the search for mutually beneficial discussion on the best response to complex medical problems. And if you think I'm barking up the mad tree at the full moon in the forest of soft in the head³ then bear in mind that some, perhaps much, of this already goes on within the NHS. The potential is there, and is used, it just needs to be maximised.

Anyway, in summary: (and for those of you who couldn't be bothered to read the whole thing) we need a system to provide care across the country for all of the people all of the time in a manner that focuses on treatment not profit, connects all of its various tentacles in a productive fashion and strips people of the anxiety of avoiding important medical attention for fear of cost. Now – what shall we call it?

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