Abstract
The way to a better future for the NHS is clear from papers and correspondence in JRSM over recent years; the problem is that while clinicians may agree what is necessary, the opportunity for change is in the hands of politicians who are not prepared to admit that they have made mistakes in how they have managed the NHS.
I was particularly struck by the importance of the paper by Lale and Temple, 1 which clearly demonstrated that successive ‘redisorganisations’ by successive governments have done more harm than good. If many of the complex layers of management could be dismantled and the stifling restrictions on professionalism and clinical freedom removed, this would cut costs and increase productivity and survival rates. Furthermore, there would be an immediate improvement in morale among clinical staff which would start to remedy the serious crisis in recruitment and retention of doctors, nurses and other productive staff.
I was very surprised that Lale and Temple’s paper did not create more headlines in the medical and lay press. I did have a letter published in a national newspaper highlighting their work, but I have seen no evidence that awareness of their important message has occurred.
Politicians have publicly stated that they do not wish to listen to experts. As far as I know, no politician has ever made any attempt to evaluate the effect of their ‘redisorganisations’ over the last 70 years, a period in which massive medical advances have been achieved with the aid of careful analysis of evidence and clinical trials.
I have written to politicians over the years about this and some of them have stated that they agree with me, but this has never got any further than letters to the Secretary of State which receive dismissive replies but no reasoned argument. Depressingly, my current MP, who is medically qualified, does not agree with me and has replied to me patronisingly that politicians know best.
Until we as a profession find a way of changing political mindsets, I am pessimistic about the prospects of a better future for the NHS.