Observations Body Politic

Take me to your leader

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2092 (Published 03 April 2013) Cite this as: BMJ 2013;346:f2092
  1. Nigel Hawkes, freelance journalist, London
  1. nigel.hawkes1{at}btinternet.com

Management fads come and go, and integrated care may be just the latest fashionable policy in the NHS

For an organisation that sets a lot of store by evidence, the NHS is easily swayed by fashion. An idea takes hold, gains purchase, and becomes the accepted wisdom so swiftly that you have to be on the alert to keep up. Perhaps that’s why there are so many breakfast meetings, seminars, and one day conferences in which the same cast of people exchange views on whatever idea has temporarily captured the zeitgeist.

Currently, it hardly needs saying, integrated care is it. The parliamentary select committee on health strongly endorses it, the think tank the King’s Fund proselytises about it, and the Labour Party—in the person of Andy Burnham, shadow health secretary—has proposed yet another reorganisation of the NHS in England in an attempt to achieve it.1 I may just have a suspicious nature, but when everybody is in such warm agreement my instinct is to take to the hills.

A US psychologist, Carl Rabstejnek, has identified at least 100 management fads and fashions since the second world war, from “acceptable risk” at one end of the alphabet to “zero defects” at the other, taking in “just …

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