NHS will break even

With billions of new money pumped into NHS over the last few years, what will it take for NHS to break even?
Well, Kate Silvester says that there's 30% waste to be taken out of a given care pathway at any point in time. Not that NHS is wasteful, just that the pace of change: of our understanding, of medical technology, of medicine, is so fast that a care pathway which was efficient and perfectly designed around patients a few years ago is no longer the best we can do.
BUT - politicians' mantra is "fewer managers, more front-line staff". Forgive me, but front-line staff have a day job looking after patients, and are rarely if ever given any opportunity to look ahead strategically and plan to change things.
A quick look at management to staff ratios finds NHS ratio at one manager for every 25 staff, compared with a public sector average of 1:18 and a commercial average of 1:15. If NHS is supposed to model itself on the best commercial competitors, then might it need more managers, rather than fewer? A look at service improvement reveals a similar figure - across the commercial world the ratio of dedicated service improvement staff to everyone else is around 1:100 - for a company with 1500 employees, they would have 15 staff dedicated to looking at ways to improve the way they do things. Picking a large hospital trust (nameless for confidentiality reasons) of around 12000 staff, they have around 6 service improvement staff (and I'm not counting that "everybody has service improvement in their job description" - how many staff in commercial organisations don't???) - and they are comparatively successful with a comparatively high ratio (1:2000!).
Public Services in Britain do have something to learn from successful commercial companies. But not necessarily about cutting costs. And commercial companies have a lot to learn from the operation of some public sector organisations