Hospital notes 8 March

The old tug of war continues in the NHS. Local bodies ration surgery in order to balance the books, while the Department of Health says clinical need must be the only criterion (while doubtless whispering behind its hand that the NHS still has to balance the books). The fact is that the NHS can't afford to do everything but ministers want to be as distant as possible from any decisions on rationing. NICE meanwhile doesn't take into account the total amount of money available to the NHS. So no one stands up and takes responsibility and sick proles get elective surgery or not, depending where they live. Business as usual.

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Too many hospitals are coasting along, settling for meeting minimum standards, says Jeremy Hunt. He is to attack a culture of "complacency" and "low aspirations", which he believes is holding the NHS in England back. He is expected to say while there is a concerted effort to tackle failing hospitals, there should also be a focus on "mediocrity".

Can it be a coincidence that this is precisely what Michael Gove and Sir Michael Wilshaw say about coasting schools?

Douglas Carswell likes to ask what supermarkets would be like if they were run by the state. Well, the hospital service sadly gives us a clue. Before targets, even The Guardian, champion of state sector provision, concedes,

The targets for 18-week referrals to treatment and four-hour waits in A&E were introduced precisely because the service had lost sight of the suffering and distress of its patients. People died while waiting months for cardiac surgery. Others waited years to have cataracts removed. Patients routinely waited in pain and discomfort for many hours before receiving "emergency" treatment.

No sign here of innovation. No rewards for working up ways of doing things differently. A huge central state service rewards compliance with the old. Individual doctors will embrace medical innovations. But who is empowered to try new ways of organising and delivering services?