The NHS reforms probably represent the biggest change to this service in a generation. But few people seem to be talking about what's really wrong with it and whether the current reforms will make it better.

If the NHS was a patient, it would be as if it went, feeling a bit queasy, to see its GP more than 20 years ago. Without warning, it was sent straight to hospital, kept in, operated on, helped to recover, operated on again, and again, and then again.

And now, just as it's been finally been given the date when it can return to its family, it's got to go under the knife yet again.

What's odd is that nobody has really said all this time, what it is suffering from - other than very general non-specific conditions (too much management, too much bureaucracy and the patient not being put first).

Oddly, nobody is describing "too much change" as a serious problem in itself.

One might imagine that the current level of news coverage would illuminate the issues that the NHS faces. But apparently not. The story now is whether or not Mr Lansley will survive. And while the ups and downs of his career might be interesting, he's not the patient.

Of course, this is not the first time the NHS has undergone massive change. The Guardian has helpfully charted the recent chronology for those who need a refresher.

It is little wonder that public support for the reform of the NHS is thin on the ground. We don't all agree what's wrong with it. And we've been told that it has been getting better and better. Is it not well yet?

Successive governments over the years have promised a better health service. Labour, in 2000, set out their bold vision: "The vision of this NHS Plan is to offer people fast and convenient care delivered to a consistently high standard. Services will be available when people require them, tailored to their individual needs."

In 2007, we were asked to embrace world class commissioning which heralded better health and well-being for all, better care for all, and better value for all.

And in the midst of all this we were promised electronic health records, a treatment that appears to have been abandoned, not without cost. According to the National Audit Office, which concluded that "the £2.7 billion spent on care records systems so far does not represent value for money, and we do not find grounds for confidence that the remaining planned spend of £4.3 billion will be different".

And lest we forget, there was Choose and Book - a national electronic referral service which gives patients a choice of place, date and time for their first outpatient appointment in a hospital or clinic.

Surely before we embark on yet another bout of disruptive and expensive treatment, we need to look at the diagnosis.

• What is actually wrong with the NHS?
• Have previous attempts at reform been successful?
• And what makes anyone think that this time the reforms will cure the ailment?

I don't think anyone is saying that the NHS is necessarily in tiptop condition. After all, it was born in the 40s.

• But just as in our own lives, we might want to get a second opinion.
• We might want to know whether the proposed treatment has worked successfully elsewhere.
• We might want to look at the surgeon's track record.
• How many times, we might ask, has he or she successfully performed this operation?
• We might also want to know whether we could cope with yet another bout of treatment.
• How much of the previous medication is still working its way through our system?

And we'd need to be quite frank with the doctor. As a whole, most of us don't trust politicians. According to MORI, just 14% of us believe that politicians will tell the truth. Whereas 88% of us will trust doctors to do the same. And just over half of us believe that the "ordinary man or woman in the street" will tell the truth.

In reality, it would always be difficult for a politician to sell the case for change. Add into the mix the possibility that the current round of change could be hiding something more radical (it's not the first time) and you have a recipe for massive disengagement and denial.

I'm sure that things will have to change in the NHS. Maybe the treatment lies in everyone paying more tax, lowering expectations and delivering change more slowly.

But before we embark on any course of inevitably costly and disruptive treatment, let's all agree what the problem is and whether we're all prepared to live with the risk of things not going according to plan.

Not all treatments are successful. Sometimes, the patient dies.

Follow Mark Fletcher-Brown on Twitter: www.twitter.com/morque