A Liverpool health experiment which just might save the NHS
When doctors say "We need to have a new conversation with the public", nobody is waiting for good news.
True to form, the wise men at the top of the NHS in their headquarters in Leeds and Liverpool have identified the source of their pain: it's us.
We are victims of our own lifestyle choices, demographically ever more numerous, and culturally driven by untameable expectations.
We drink too much, we are too fat, we smoke, and we do not exercise and the average age of the population is increasing.
The pressure is intolerable.
A morning at A&E or a GP's surgery is like a scene from The Day of the Triffids.
No power on earth could save us from ourselves and we are lucky to live as long as we do.
Nothing new here. The NHS and the people were never a perfect fit.
When it began, in 1948, it was thought that demand for the NHS would trail off after an initial rush for treatment.
By the 1950s the NHS was already a fiscal nightmare, a 'bottomless pit': free medicine for all, it turned out, was a stony road leading to an 'infinity of demand'.
So it has been ever since - but there has never been a time quite like this.
In a report published early last year, the head of the NHS, Simon Stevens revealed that the annual deficit of the NHS will soon reach £30bn - a shortfall big enough to pay the Army and the Navy put together.
That kind of money not only talks, it changes the conversation.
Until now, the assumption has been that the NHS - like the Greeks - could muddle on forever. Well, we have just seen what happened to the Greeks.
Strategists throughout the Health Service have begun to think the unthinkable.
'Unsustainable' is only the word they use in official parlance.
A Liverpudlian doctor featured in a Panorama Special, NHS - The Perfect Storm tells it like it is: Unless we change the way we do things, the NHS in England will die.
Liverpool is something of a special case.
Since records began, the city has bumped around at the bottom of almost all league tables for healthy living.
The new Healthy Liverpool programme - backed by the City Council and the Liverpool Clinical Commissioning Group - is the city's latest answer to its mountain of health problems.
Presented as a manifesto of sweeping - even 'revolutionary' - change, it promises Liverpudlians longer, healthier and happier lives.
The scheme involves an all-out attack on unhealthy lifestyles combined with a massive shift of care - and resources - from hospitals and into the community, and a joining up of the NHS with other health and social care services.
These are familiar tropes of health service reform instantly recognisable from the past.
Priority areas for the Healthy Liverpool project:
Reduce excess deaths among adults under 75 with serious mental illness
Decrease hospital admissions for self-harm
Increase the proportion of people who get psychological therapy by 25%
Increase proportion of people still at home after 91 days after hospital discharge
Reduce permanent admissions for over-65s to residential and nursing homes
Reduce emergency admissions for vertebral and hip fractures by a quarter
Less than 90% of patients waiting 62 days from referral from screening service to first definitive treatment
Increase bowel cancer screening rate to 60% and breast cancer screening rate to 70%
Reduce smoking prevalence from 25.2% to 20.2% by 2020
Reduce children's admissions for asthma by 28.8% by 2016-17
Reduce excess weight in four and five-year olds
Increase the number of women breast feeding at six to eight weeks
Reduce coronary heart disease emergency admissions by 18.3% by 2018-19
Reduce emergency admissions for Chronic Obstructive Pulmonary Disease by 26.9% by 2018-19
Reduce potential years of life lost by 24.2% by 2018-19.
Improve accuracy of the learning disabilities register in general practice
Increase percentage of people with learning disabilities receiving an annual health check
We have heard it all before, so why should it work now?
At the core of the programme is a very simple idea: healthy people do not go to hospital.
Everything possible must be done to prevent people becoming ill, by encouraging healthy lifestyles.
Doctors and other health workers are charged with anticipating problems in their patients, and trying to act before they get ill. They are also taking healthy living messages out into the community.
Little things can make a big difference. Statistics show that even walking for 20 minutes a day makes a considerable reduction in hospital admissions.
When people do get ill, the aim is to treat them as close to home as possible, and if they do need hospital care then to minimise the length of their stay, by ensuring coordinated care is available when they leave.
We do not need hospitals, one member of Liverpool's CCG exclaimed - with only a little exaggeration.
And as if to reinforce this message, the new Liverpool Royal Hospital is being built with fewer beds than the hospital it is replacing.
In the future the only people who will be admitted to hospital, will be patients who really need to be there.
At the end of Healthy Liverpool programme, a senior doctor told me, there will be fewer hospitals in Liverpool.
There is a growing realisation that the problems are not going to be solved by the NHS acting alone.
The NHS can put its own house in order, but we - the public - need to change the way we live, and the way we use the health service.
Changing the habits of a lifetime is not very easy anywhere - in Liverpool it could be particularly challenging.
The reckoning in Liverpool is that they have only got about 24 months before the system starts to grind to a halt.
That is the conversation the NHS needs with the public.
One Liverpool GP told Panorama that is going to be a difficult ask.
"Realistically we should be the healthiest, happiest, best that we have ever been as a population. The knowledge is out there. Things are good and bad for you. But in reality we are getting worse.
"Actually that 10 minute or 15 minutes you have with somebody is not going to change their lives. Its about realizing that - and the reason why you are not feeling great is nothing medical.
"It is more social and it is more about life itself than being depressed and needing drugs.
"This is bigger than this practice. This is bigger than the NHS.
"The NHS can't cope: no health service would cope - anywhere."
NHS: The Perfect Storm is on BBC One at 20.30 on Monday 13 July 2015 and afterwards on iPlayer