The political problem for David Cameron is that all of the current problems of the National Health Service can be blamed on this current Government ‘diverting’ around £2.4 bn resources into implementing a complicated disorganisation.

Lansley, a co-author of ‘Equity and excellence: liberalising the NHS’, the key White Paper of 2010, has always argued that this was never a ‘top down reorganisation’. It was a ‘devolving reorganisation’, according to him re-distributing power to clinical commissioning groups inter alia.

If the Thatcher and Major decades could be characterised as implementing a sort of ‘market’, with purchasers and providers, the Blair (and less so Brown) years might be characterised as a restructuring period for the NHS. This is after all where the PCTs were originally created.

One of the biggest criticisms of how the NHS was run in the latter period of the last Labour government is that CEOs sought to ‘game’ markets so that NHS Trusts could without any difficulty obtain ‘foundation trust status’. Some Trusts for budgetary reasons employed unsafe staffing. With a weak regulator at the time, with culpable CEOs simply moving onto different jobs, the rest of NHS (and some relatives tragically) have been left to pick up the pieces.

Andy Burnham MP is thought to be fairly safe in his Shadow Secretary of State job until 2015 at least. Whether he can remain spend a helpful period of time as a Labour Secretary of State in health, implementing ‘whole person care’, is quite a different matter.

Burnham has categorically pledged to repeal the Health and Social Care Act (2012). He has pledged to reverse part 3 – the section on competition. He insists that he ‘will ask to the same structures to do different things’. This approach is to avoid the accusation that Labour will embark on yet another costly disorganisation, knowing that the public know there have been quite aggressive cuts in nursing staff numbers already.

This might seem fine – but it will not address any latent pathology in culture in the NHS. Unless Labour attempts to consider this build up of pathology, which has taken decades across both Labour and the Conservatives, it is possible that it could become really malignant again. At worst it could kill the NHS.

Evidence that the pathology is relapsing is, for example, given by the recent ongoing debacle at Colchester.

Ecosystems do change however.

Look at Death Valley.

The wettest year on record in 2004/5 transformed the forbidding wilderness of scruffy mountains and scorched earth into a vividly unfamiliar world of wildflowers and reflecting pools, triggering ecological cycles not seen before on so large a scale.

The intense heat was swapped for an environment which living things could flourish.

Against a background of snowcapped peaks, the region’s lands suddenly became populated by bright yellow, pink, white and deep purple blossoms spreading out in all directions.

And why did markets cause so much a problem?

We turned from a market economy to a market society.

Why is this a problem? According to Sandel, two reasons: First, inequality. As money becomes important to access to the essentials of the good life — such as decent healthcare — inequality becomes more and more important.

And the second reason is that when market thinking and values enter the sphere of certain social goods and practices, they change the meaning of those practices — and crowd out attitudes and norms worth caring about.

Sandel gives the example of cash incentives in schools.

Some schools in New York, Chicago and Washington DC have begun programs to motivate students from disadvantaged backgrounds by offering money for grades: $50 for an A, $35 for a B, and so on. A program in Dallas offers students $2 for every book they read.

What was observed at the end of the experiment was that all was more was offered for students reading books, students did indeed read more books with greater financial motivation. But they also read shorter books.

What this illustrates is a false assumption held by many economists, says Sandel: that markets are inert and don’t taint the goods they exchange. This, Sandel argues, may very well be true with material goods, but not so with medical services, engaging in civic life. According to his thesis, market thinking can actually change the “character” of these social practices, so we have to really think about where markets belong and where they don’t.

Look at how GP practices are paid to collect some data under QOF – the use of some of this data is not at all clear.

The National Health Service is in an intrinsically human phenomenon. It is not adequately encapsulated by a series of equations concerning industrial productivity.

Margaret Heffernan gives another striking example.

Gayla Benefield uncovered an awful secret about her hometown that meant its mortality rate was 80 times higher than anywhere else in the U.S. But when she tried to tell people about it, she learned an even more shocking truth: people didn’t want to know.

It turned out the hometown was full of a substance called asbestos, causing individuals to breathe in asbestos and develop fatal lung disease.

In the best organisations, those charged with leading the organisation welcome challenge because it helps the organisation to learn.

But the recent history of the NHS is littered with the casualties of the fear of acknowledging error, especially where such errors might be the tip of a very large iceberg, in an organisation that is more  systematically flawed.

Kim Holt, Gary Walker, David Drew, and Steve Bolsin – the list of those who have had the courage to blow the whistle is a long and honourable one.

But people who have tried to speak out have invariably suffered in some form themselves.

The NHS will be doing its ‘change day’ soon in 2014. Part of a way with dealing with a problem, whether it is an assumption of market values not to the benefit of the patient, or a lack of a safe environment to ‘speaking out safely’, is admitting the problem exists.

Only then can you unfreeze yourself from this ‘frozen culture’, shift culture, and move to a new cultural destination.

Whatever is legislated about structures, this change must happen in the next government. It will also be essential for the safe implementation of ‘whole person care’, or similar.