Next month is the 60th anniversary of the second reading of the bill that led to the foundation of the NHS in 1948. But the NHS is in no state to celebrate the occasion, with a record overspend in a period of record growth and, for the first time, a chief executive lost to force majeure.

The overspend and the decision of Sir Nigel Crisp to “retire” aged 54, after more than five years at the helm, are, of course, intimately connected. And it is difficult not to feel sorry for the outgoing chief executive. Sir Nigel is a man of considerable intellect and undoubted integrity. In the words of one senior Whitehall official, he had changed in less than a year from “the blue eyed boy of Whitehall to a member of the fingertips club,” meaning that he was holding on to his job by his fingertips.

A year ago he succumbed to considerable pressure from the Whitehall machine to apply for the cabinet secretary's post to prevent the obvious (and successful) candidate, Gus O'Donnell, from having an easy win. At the time, NHS waiting times were falling, and service improvements were visible. Sir Nigel's pitch was that as an experienced manager he could organise Whitehall to deliver across the …