If you commercialise health care in a way that is ineffective and inefficient, focussed on spurious targets, government initiatives (which change with the Health minister), and the lunacy of working inside a PFI contract. The restrictions on what different folk can or can not do, what is within their budget you will end up with the increasing mess that is the NHS in England and let us be frank it is NHS England this report in the Independent is about. Things are not rosy in some parts of NHS Scotland or Wales either but often that is related to PFI contracts so beloved of New Labour to keep the real costs of their jobs for the boys and girls out of the public view.
You are a new nurse in a PFI hospital, your nursing manager will probably tell you that as there is a contract for cleaning hazardous biowaste (spilt blood or urine) it is not your job to clear the mess up - now it is on record this can take up to two and a half hours to happen, so all you can do is prop one of those daft yellow sandwich boards over it - maybe you would start to find your morale starting to slip.
Maybe you will also get fed up with visitors telling you how manky the place is as a third of the contract cleaning staff have pulled a sicky that shift to watch Eastenders and the ones who have turned up will make sure they take every minute of their allowed time to clean their specified ward first.
Then you'll find that design flaws in your PFI hospital means there is no where to store dirty laundry or yellow low risk bulk bags so they have to sit in the corridor further annoying visitors.
The basic need to provide an environment condusive of quality of care is just not in place and to save money the Trust will not fill the expensive nursing posts leaving wards short handed because the senior nurse has had enough of covering for two colleagues and thrown a sicky to get a break of chasing well meaning but inexperienced nurses while filling in the piles of bumpff, line manager's require to measure performance of what they think important but has little bearing on meeting patients needs or expectations - and while they are getting prizes from the DoH for meeting targets (like North Staffs) patients are dying unecessarily for reasons any nurse or doctor would quickly identify for you but as management have stopped giving a stuff and the recent wheeze from DOH England has been to shut up whistle blowers - you do not bother.
How do I know this? Well I have taken part in enough clincial governance and quality audits of hospitals and seen this as work in progress ince 1996 while the DoH English Quangos pass the buck and no one tells the truth because God knows what new initiative the politicians in DoH England will think up next.
I hope the Kings Fund Sociologist (in the original Independent article) reads this - it is not standards are low amongst junior doctors and nurses who do the bulk of ward work, it is morale (on which pay has no impact) and Lansley's latest political wheeze from the DoH is going to make things far worse in NHS England as the patient is further and further from the centre of care than ever.