Because that's part of the problem and why it is struggling. As the population grows and

diagnosis gets more frequent, the number of patients requiring attention is growing fast. It is extremely difficult to be able to keep up with growing demand if you have so much bureaucracy and so many disjointed departments, suppliers, processes etc. All the willy-nilly outsourcing (for example) with civil servants coming up with more and more process to try to bridge the gaps has created an absolute mess on a procedural level.

The leaner the organisation (and no, I don't mean less people, just more efficiently utilised), the more possible it is to grow simply because you've put in thought into how to abstract processes and structures which will survive with increased demand in the future. Of course at some point that too will reach a limit. Nobody has a crystal ball, but it just makes sense to set up in a way that you anticipate change.

Assuming Trump doesn't press the button, the population is going to grow and grow further. If attention is not spent on cleaning out the whole system and structure then it will be continue to be incapable of growing to meet demand, just as it is showing already. What happens then is that you need to throw exponentially more money at it to achieve small improvements.

Posted By: Steve in Holland, Jan 8, 17:08:53