Intended for healthcare professionals

Choice

The NHS: last act of a Greek tragedy?

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7239.0 (Published 01 April 2000) Cite this as: BMJ 2000;320:0

Imagine that you are the British prime minister sitting in 10 Downing Street being driven mad with frustration. The damn NHS won't deliver. You've tried inspiration, perspiration, leadership, persuasion, threats, bribes, measurement, modernisation, information technology, hit teams, clever new quangos with still cleverer acronyms, wheedling, and even straightforward pleading, but still satisfaction falls, targets to reduce deaths from cancer are not being achieved (p 895), waiting lists grow, dreadful stories appear in the media, and the moaning goes on. What now?

Last week the government reached for the ultimate weapon, the one it least likes to use: money. The NHS is going to receive an extra £19.4bn over the next four years, an annual increase of 6.1% (p 883). “The prime minister,” write Rudolf Klein and Jennifer Dixon, “has nailed his personal standard to the mast of the NHS, and if the ship goes down so will his political reputation.” Will it go down? Klein and Dixon think it might.

The problem is how to achieve change throughout a huge organisation like the NHS. The traditional model is that ministers decide and professionals deliver. Sadly, it doesn't work. One reaction to the failure is to try a more sophisticated model. Another reaction is to strengthen ministerial power, to shout louder. The government seems to have chosen the second option, and Klein and Dixon think it is wrong. Rather than frogmarching the NHS towards best practice, the government should be motivating professionals within the NHS to innovate, experiment, and learn from each other. Great leaders have the strength to abandon themselves to the wild ideas of others. Weaker leaders want to control everything. Maybe we are too pessimistic, but there is a sense in which Tony Blair, the NHS, and the Labour party that founded it may be moving towards the final act of a Greek tragedy: a good man with an undoubted commitment to the NHS may be undone by a fatal flaw, an inability to let go.

Even if one much loved British institution is going to sink there is a fighting chance that another—the journal formerly known as the British Medical Journal (now the BMJ)—is going to flourish. The electronic revolution might be about to sweep us away, but our electronic version is so far going well. This week we are “rebranding” the eBMJ as bmj.com—mainly because if you type “eBMJ” into your computer you get nothing, whereas “bmj.com” will bring satisfaction. Last week some 120 000 people visited bmj.com. Most of them don't receive the paper journal, and most readers of the paper version don't visit bmj.com. They should. They will discover much that is not in the paper version, including rapid responses, extra news items, and a full archive back to 1994.

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