Right, but "not doing what they should do" is different to "can't do what they want to do".

It's not that different, no. At the scale of large institutions these two things blur together significantly. They "can" fire staff for incompetence in theory but if they actually do that more than once in a blue moon then the unions will revolt, so they develop a culture of never actually doing so because that's easier than trying to figure out if this time it won't cause a backlash.

The source of disagreement here isn't actually different levels of knowledge of the NHS's inner workings, it's that we're zoomed in to different scales. I'm looking at the forest, you're looking at the trees.

For example, you cite a bunch of different NHS-specific accountability mechanisms and say, why didn't each one specifically work? Elsewhere you argue the NHS isn't actually a government department because the different subdivisions claim to be independent and use names and concepts borrowed from the private sector like "corporation" and "board". To me this seems bizarre. It's like the author asking why everyone was repeatedly ignoring BPEWS and other warning systems. They didn't work because of they operate in the context of a massive Soviet-style state run bureaucracy. The primary constituents to which such bureaucracies are accountable is always themselves, so ability to self correct in such orgs is always a mirage regardless of how many titles and acronyms are invented. Dysfunction compounds and the system degrades. Asking why these mechanisms didn't work is like asking why the Soviet Parliament didn't do anything to correct human rights abuses of its citizens - it was because despite using names taken from democratic systems the resemblance was only superficial and skin deep.

The USSR collapsed and the capitalist west didn't because capitalism is a set of evolved mechanisms that were patched together slowly, over time, aligned with the natural way people actually think and work. Just like people's bodies - like any evolved system - it isn't perfect and sometimes goes wrong. The mistake is to react to that by saying, oh, this looks easy. We can do it better! Let's just start with a blank slate and get the smart people in the government to work out the details. The results are poor because everything they created was just a shallow imitation of the evolved mechanisms that they were trying to beat, but by then they're in too deep and can't admit that the system is failing.

The story this Guardian editor recounts is one of deep, systemic malaise and corruption at every level. As the girl was literally dying, the on-call doctor was working from home and refused to come in! How often had they been doing that before this story happened? From the general collapse in GPs actually seeing patients we can infer that this is a widespread culture. Asking "where is the NED" isn't going to fix this because they were probably WFH too, and the NED is far more concerned with being liked by their colleagues than their patients.

In recent weeks Gorbachev died. He became a hero to many for admitting what was obvious to others right from the start - the USSR wasn't working and couldn't be fixed via incremental reforms. It was rotten from the core and unfixable by design. He let it collapse rather than prolong the disaster by yet more decades. The UK needs a Gorbachev who will square with its people because the NHS is literally collapsing:

https://www.theguardian.com/society/2022/aug/14/ministers-ad...

... and it can't be repaired by adding a few more forms or yet another accountability officer. It will never work as well as a non-state system can.