No frills: Basic services. Fast, efficient, and result driven. If you want business class comfort, you pay for a business class hospital. The NHS would provide hospital not hotel service. No optional extras—no lifestyle, cosmetic, or non core surgery. A non negotiable list of essential medications generated centrally. If you want medications not on the list—you pay. No more, no less.

365 day service: Same healthcare, same staff, same service everyday. Non unionised—from porters to pilots; care workers to consultants. Multi tasking—doctors push trolleys, and nurses make beds. And, you know that when you turn up, it flies. 

Clean modern ergonomically designed aircraft: Wards redesigned for cleanliness. No corners, no hidden spaces, and everything removable so wards can be hosed down, cleaned, and turned around overnight. No cupboards, radiators, windowsills, or furniture and fully portable beds.

Pay for extras: Rent your bed linen on admission, or buy disposable. Food provided by competitive franchises tendering for hospital. Non core nursing duties either provided by family or purchased from an outside provider. Metered light, heat, telephone, and television.

Online booking: Make your own outpatient appointment—a credit card non refundable deposit to discourage missed appointments. Book your own admission—premium times attract premium deposits. Pay for priority boarding if you wish.

No travel agents: No GPs.

Airports compete: Cities and communities compete and subsidise Ryanair because of the employment and economic benefits of being a Ryanair destination. Similarly, cities and communities would compete for hospitals because of employment, ancillary industry, and the generation of disposable income. Hospitals are a major business—creating local wealth, not draining resources.

Amazing success: Love them or loathe them, Ryanair thrives while other airlines struggle.  Low cost travel accessible to everyone. Can we say the same about the NHS?

Domhnall MacAuley is primary care editor, BMJ