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This story really demonstrates how limited financial and clinical leadership are in their thinking. The days of funding capital replacement programme, effectively by central pots of 'free' money' (I know they come at a cost) are long gone. The world is continually evolving but the business end of the NHS doesn't seem to understand how it is.

New models of financing are already in place in hundreds of hospitals across the world, including NHS hospitals. But that message hasn't hit the ground running, so hospitals such as Torbay are left with aged stock and reducing activity - for the want of some enlightened thinking.

Pathway analysis only ever seems to work when the downsides are being considered, yet anyone can see that ageing capital stock = reduced efficiency. So new capital stock = increased efficiency. To have any chance of effectively implementing efficiency savings projects new stock is vital. The models of financing are out there - and they are far from unaffordable.

The NHS just has to push on an open door.