Intended for healthcare professionals

Reviews Personal views

More and better management is the key to fixing the NHS

BMJ 2006; 333 doi: (Published 10 August 2006) Cite this as: BMJ 2006;333:358
  1. Stephen Black (, management consultant
  1. PA Consulting, London

    Recently Paul Miller, chairman of the BMA's consultants' committee, accused my profession of being a “large part” of the NHS's problems (,8122-2215070.html). His comments typify the arguments of those against reforming the NHS. To these people all problems—deficits, long waiting lists, infection control problems—result from lack of resources, bureaucracy, government interference in clinical judgment, and the “greedy” private sector. Things would be much better if we didn't waste money on big IT systems, independent treatment centres, management consultants, and private finance initiatives and instead spent it on “frontline” staff. This sums up the attitude of the leadership of the medical profession to NHS reform, but the underlying assumption is that the only thing that matters is how many doctors and nurses we have.

    This assumption is demonstrably untrue and pernicious—distracting the NHS from seeking easily achievable improvements that derive from better organisation (which might—horror of horrors—require more spending on managers or computers). Changing how a hospital is organised can improve the quality, quantity, and speed of patients' care more than the most extravagant spending on doctors and nurses does. Evidence for the benefits of better organisation can be seen in …

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