@TheNovice - Browns PFI? Who was the PM who presided over the introduction of PFI schemes in the UK? Hint- it wasn't Brown.
When you say the NHS is inefficient, what institutions and organisations are you comparing it to, and what performance indicators are you measuring to arrive at your conclusion?
I would agree with you that there is too much middle management. The NHS is actively addressing this. As an example, Pathology services in East Anglia are being rationalised, and where there were around 28 middle managers of the different discipliines within pathology currently spread across 7 hospitals, There will probably only be 4-7 after the rationalisation. This kind of reorganisation, and centralisation of services is not just happening in East Anglia or just Pathology.
I simply do not believe your comment about 4 clerical staff solely involved with booking in patients for 2 doctors.I spend a lot of time in many different hospitals across most of the south of england as part of my job. Never have I seen anything like this.