I think the NHS is at a crucial point in its history.  A vast amount of money has been invested in it recently under this government. Yet the question has to be asked, does it provide the services people want in the way they want?  If it doesn’t can this be changed or improved and if it does, can this be sustained.
I also want to ask  how can the process of  health care become more democratic and modern.  Obselete and over staffed management systems, Doctors and Surgeons who seem to dominate and Bio Medicine and Pharmaceuticals which control and lead.
Lets take some recent changes and their sustainability and real effects.  The creation of extra levels in Nursing at a clinical level: The Specialist Nurse and The Nurse Consultant, brought in I would imagine to keep clinical experts on stream, were only semi-successful.  Yes they are jobs of better pay and allow nurse to continue in a clinical career ladder, but they have no real power (at least according to the KIngs College Review of Nurse Consultant Posts)  The idea may have been to keep Nurses as clinicians and not as Managers, but then they also created the Nurse Manager Posts and can end up in competition with Consultant Posts in less enlightened hospitals.  senior nurses are now allowed to prescribe ( with the relevant subscribing qualifications) but the seperation between Doctors and nurses and the way the public view them exists to the detriment of nursing in my opinion.  Nurse Consultants were not given rela power because of the power doctors wield in the NHs and that the governement did not want to upset them. The disaster that has become NHS Dentistry was the spectre they saw.
So now Gordon Brown talks about cleaner hospitals, real cleanliness costs money and is met within community.  In the past when local workers felt some relationship to their hospital, cleaners felt an ownership of their ward and took a pride in their work. Lowly paid contract workers don’t, no matter how many Modern Matrons or targets you have (by the way the NHS doesn’t have targets anymore as the word “target” is not considered friendly)
So I come back to the unpalatable question can the NHS be sustained as it is, if after all this investment and apparent changes, the needs of both satff and patients are not being met.  
Is it time we changed the system as a whole, so many people do not trust their doctor or the drugs they are offered, or want drugs they are not offered.  Others visit a homeopath or acupuncturist, chiropractor or other alternative practitioner from the outlandish to the everyday and often for everyday things that a doctor wouldn’t give you the time of day over.
Perhaps its time we  broke the Doctors and Medical-pharmaceutical control over the NHS and opened it up more fully to other licenced practitioners.  Osteopaths are licenced by an act of parliament, why not bring this in for Counsellors, acupuncturists and Homeopaths with the full and approved training?
My last question is one that rattles around in my brain about everything these days post-Thatcher/Reagan.  Why has everything turned into what can we get instead of what can we give. I don’t just mean in terms of money, I don’t want more charity I would like to see an encouragement that people give of themselves.