Let's just admit it – the NHS is a rotten way of doing things - Telegraph.co.uk

That reason is as simple as the question above, but it can never be publicly stated by the reformers. They cannot even admit it in their heart of hearts (assuming they have such an organ), because it is a politically unthinkable thought. It is that the National Health Service is, always has been and always will be a rotten way of doing things.

This is hard to see because the NHS arose from a good idea – that people should be able to get good health treatment without financial worry. Unfortunately for Britain, this was acted upon at a time when centralised state socialism was at its height. So the NHS was constructed to carry out Whitehall commands. It was even imagined that these commands could be so efficiently obeyed that the cost of care would actually fall. The thing was a fantasy of the state planner. It is the reality, not the fantasy, which strikes the patient – and the patient's friends and relations – every day.

I must have visited roughly 20 old people in hospital over the past 20 years. I have never seen a ward in which the old were being well looked after (though obviously I have often come across good individual nurses and doctors). The general level of care has been mediocre or low.

Like most people, I have also visited friends and family of all ages in hospital. Again, I have never known anyone on a prolonged course of treatment who has not suffered from the loss of test results (or the alleged loss of test results, which then turn up later); and/or the cancellation of appointments; and/or the confusion of times about when to be somewhere; and/or a long wait when he/she is told to be ready by, say, 8am, and then is not collected until, say, 3pm. I have never known a patient who has not been asked to repeat to one nurse/doctor/receptionist details he/she has already told another. In several visits to casualty over the years, I have known only one occasion when there was no serious wait before seeing a medical professional (and even then, though I saw a nurse quickly, I had to wait four hours before a doctor could – without looking at me – order my release). I have known patients kicked out of hospital dangerously early and patients kept in hospital without anyone knowing why they were there.

I have never known a patient in an NHS hospital say that the food was nice. I have never been to a general hospital in which all the staff could accurately direct people to the right ward. I have rarely been to an NHS hospital which was spotlessly clean, or to one in which every member of staff spoke comprehensible English. And never, except for when I had my tonsils out in about 1964, have I visited a ward in which it was unmistakably clear who was in charge. In more recent times, I have always seen nurses chatting to one another at the desk in a ward, rather than checking on patients. I have frequently known people contract serious infections in hospital. Sometimes, they have died of these infections. In a hospital near us six years ago, 90 patients died of C.difficile: many of them, suffering from diarrhoea, had been told to "go in their beds".

I have also noticed that those who, out of concern for busy staff, have not made a fuss about their treatment have always suffered as a result. In some cases, they have died. I have never known an NHS hospital where it was anyone's job to take overall responsibility for the welfare of individual patients.

These experiences are not untypical. They must be balanced, of course, against good ones – the consultant who noticed something dangerous in a brain scan that had been missed by others, the highly competent paramedics, the nurses who have shown particular care for a sick child. But my point is that the bad things do not arise from "cuts" (which never happen) or even, chiefly, from the defects of bad individual staff (though this is a growing problem as training has got sloppier). Most of these problems are not, in essence, medical either. They are to do with a demoralised and incompetent institution. They arise from what the NHS is.

Far from being "organised compassion", the NHS is, by its nature, a bureaucracy. Bureaucracies, inevitably, are selfish. They are constructed according to the convenience of the producer, not the consumer (although, oddly, they are often unpleasant places for the producers to work in). Not for nothing does the word "patient" mean "one who suffers". Suffering is guaranteed by the system.

Why, then, do people still love saying that the NHS is "the envy of the world" (an idea that cannot be sustained after 10 minutes' conversation with any citizen of another developed country)? I think it is because of fear. There is the fear – perfectly understandable – that anyone trying to change it will probably foul it up. And there is the deeper fear that strikes us when we lie on a hospital trolley – the helplessness which makes us long to believe that it's all going to be all right.

Gradually, though, people do notice when huge enterprises set up in the name of public service do not work. This is now accepted about most nationalised industries and high-rise council blocks. We shall not go back to those things. It is at last being recognised about "bog-standard" comprehensives, wind farms and our system of welfare benefits.

One day, it will be recognised about the NHS, and the politician who seizes that moment will prosper. One day, but not, I fear, yet. Unfortunately, a lot more people will die in the meantime, martyrs to the god that failed.