No one wants a USA style NHS, I certainly don’t. I’ve seen the way it operates and I was not impressed. But turning around any organisation starts by getting the top level overall picture, dept by dept, then going down three levels and look and listen to those who actually do the work, where you inevitably get a totally different picture. Then you review the actual systems procedures against what actually happens and then start the who/what/why/when questions. Bearing in mind at all stages that clever turnaround person doesn’t really have a clue how a hospital operates and is merely trying to open up and challenge the people with the real knowledge to bring forward their own improvement. You then redraw the processes for each area, test the overall system by way of detailed review workshops to see where the weaknesses and wasted costs are and finesse it. Then the staffing and skills required can be added together with the overall budgets. Doing it at the NHS level is useless, it needs to be done at two or three hospitals, of different sizes and make up, before rolling out if successful. I would think it would take between 3-5 years per hospital, phased over a total of 8 years. The problem that the NHS has though is that ministers keep changing, governments change, and they all do knee jerk changes which still doesn’t allow them to get to the roots of the issues.......