Intended for healthcare professionals

Analysis And Comment

Steadying the NHS

BMJ 2006; 333 doi: (Published 27 July 2006) Cite this as: BMJ 2006;333:254
  1. Donald M Berwick (, president1,
  2. Sheila Leatherman, research professor2
  1. 1 Institute for Healthcare Improvement, 20 University Road, Cambridge, MA 02138 USA
  2. 2 School of Public Health, University of North Carolina, USA
  1. Correspondence to: D M Berwick
  • Accepted 10 July 2006

We believe, and refuse to be dissuaded, that the National Health Service, with its moral intent, commitment to equity, and store of knowledge, has the inherent capability to become the greatest healthcare system of any nation. Yet, lately, it seems like a boxer on the ropes, not the champion it should be.

Laudable goals

Fiona Godlee has raised a critical question about governance at the right time.1 The vision of modernisation of the NHS that emerged in the first year of the labour government was, and remains, compelling.2 Tony Blair personally led the articulation of an ambitious set of goals for reinvestment in and improvement of care, and he put his money—lots of money—where his mouth was.

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Tony Blair put his money where his mouth was


The national service frameworks that early on defined targets for better care in areas including cancer, coronary heart disease, and mental health were scientifically grounded and patient focused. Infrastructure for catalysing change grew rapidly, …

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