Intended for healthcare professionals


The “redisorganisation” of the NHS

BMJ 2002; 324 doi: (Published 16 March 2002) Cite this as: BMJ 2002;324:672

Is mass dysmorphophobia a better term?

  1. Trevor Turner, clinical director
  1. Division of Psychiatry, Homerton University Hospital, East London and The City NHS Mental Health NHS Trust, London E9 6SR
  2. London School of Hygiene and Tropical Medicine, London WC1E 7HT
  3. Middlesex University Business School, Hendon, London NW4 4BT
  4. Oswestry ST10 7HR
  5. Faculty of Public Health Medicine, London NW1 4LB

    EDITOR—After six organisational reconfigurations in the course of 15 years as a consultant I was delighted to read that a respected unit (the Health Services Management Centre) considers that there is no research evidence for the recent change.1 But would it not be useful to study the experiences of those of us, mainly senior nurses and consultants, who have had to carry on delivering clinical services amid the routine changes of management?

    For example, it takes at least two years for organisations to work out who does what, to rewrite the priorities and protocol strategies, and to settle arguments within the region/health authority/trusts as to how much money they should have even though they don't have it. Most typical is the reintroduction of arrangements that failed five years ago, under the aegis of a “robust” (or “innovative”) “change facilitation.” There is also no research into what happens to those people displaced by this process. Like sacked football managers they seem to mill around as management consultants or emerge as part of a new agency or a deanery add-on—quango-like organisations generating meetings and paperwork.

    Health service management is difficult, and I sympathise with those involved in its current rearrangements. This persistent preoccupation with appearance is a form of …

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