Intended for healthcare professionals


Doctors and managers: NHS is unmanageable corporate mess

BMJ 2003; 326 doi: (Published 29 May 2003) Cite this as: BMJ 2003;326:1213
  1. Peter G Hope, consultant orthopaedic surgeon (peter.hope{at}
  1. Lister Hospital, Stevenage, Hertfordshire SG1 4AB

    EDITOR—Conflict between doctors and managers results from the NHS's unmanageability.1 2 Corporate governance requires that product, strategy, customer, and share-holder are clearly identified, but the NHS's product and strategy are dictated externally and changed daily by politicians, patients, managers, media, royal colleges, pressure groups, health professionals (including doctors), employees, Europe, and lawyers.

    These make ever burgeoning demands for products that include health provision, disease management, illness prevention, death postponement, social engineering, lifestyle improvement, transport, education, and board and lodging, and the NHS seems powerless to refuse.

    Smith is incorrect—patients are not customers.2 The purchaser is the customer, and NHS patients are manifestly not purchasers. The government is the paying customer, demanding target hitting satisfaction, but it is also the sole shareholder providing the investment and appointing the boards. Is this corporate governance?

    The NHS is an unmanageable corporate mess. Doctors see the effects of this and blame the managers. Hence the conflict.


    • Competing interests None declared.


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