Personal Views

There must be a better way

BMJ 1996; 313 doi: (Published 27 July 1996) Cite this as: BMJ 1996;313:237
  1. Richard Nelson

    Three years ago I was sitting in the garden of a friend and colleague discussing the NHS reforms. He was dying with considerable dignity and courage. Earlier that year, as the full extent of his disease had become apparent, he had relinquished his clinical directorship to me.

    Throughout his professional life he had embraced innovation. When the Conservative government announced its reform of the NHS he was delighted. Years of stultifying management and planning would be swept away by a dynamic and flexible internal market. In this brave new world money was to follow patients. Clinical excellence would be rewarded.

    He took his place on the trust management team with enthusiasm and to the consternation of some of his friends and relations he sat shoulder to shoulder with ministers of health offering his own support and the posthumous blessing of his uncle, the architect of the NHS, to their plans.

    I was more sceptical. Successive governments have had three priorities in their dealings with the NHS: to contain costs, to deflect political pressures, and to claim any improvement in the service as evidence of their good stewardship. This reform would be no exception. There was no acknowledgment that funding was failing to keep pace with growing demand and public expectations …

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