Letters Changes in the NHS

Going to hell in a hand cart?

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2288 (Published 27 March 2012) Cite this as: BMJ 2012;344:e2288
  1. Jonathan Mark Fraser Temple, public health physician
  1. 1Public Health Wales, Cardiff CF11 9LJ, UK
  1. mark.temple{at}welshtemples.me.uk

Three small points for us all to consider.1 Firstly, only England is changing its NHS as part of the current parliamentary mess. The rest of the UK is wisely treading a very different path and delivering more effective care.

Secondly, the focus on objectives by management may not be the best way to provide the best care. As Deming said in his foreword to Walton’s book: “Understanding of a stable system discloses the devastation of people wrought by the annual appraisal of performance, futility of management by the numbers, management by MBO [management by objectives].”2 He goes on to say: “teamwork in a company, except for putting out fires, is impossible under the existing annual appraisal of performance. Everybody, once the fire is conquered goes back to his own life preserver, not to miss a raise in pay.”

Thirdly, Deming famously said “Export anything to a friendly country except American management.” North American business schools (or their European clones) are training NHS managers and observers. Yet Deming implored the Japanese to avoid the seductive approach of American business schools’ teaching because it would lower quality. The leading car manufacturer in the world learnt painfully the price of ignoring this advice.

I suspect the NHS is going to hell in a hand cart for exactly the same reason.


Cite this as: BMJ 2012;344:e2288


  • Competing interests: None declared.