One NHS reorganisation too many: time to move onBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7568.608 (Published 14 September 2006) Cite this as: BMJ 2006;333:608
All rapid responses
Dear Sarah Wilson,
May I just say in passing that your Personal View, "One NHS
too many: time to move on" is possibly the most irritating piece of self-
justifying, buck-passing I have ever read?
You begin well. "Most British doctors are not affected by NHS
reorganisations. They manage to continue to concentrate on caring for
their patients, despite the surrounding upheaval". Having established your
credentials as a life-form from another planet, you then assert that,
"many GPs and consultants don't know what the current NHS structure
is...and to them it probably doesn't matter."
Without pause to allow me to scrape my jaw off the floor, you go on to
blithely describe how the NHS has been used and abused as a political
plaything over the last ten years. You chose to highlight this as,
"Contestability confronted professional protectionism".
What? We doctors suddenly woke up from our stuporous slumber one
realised what you all were up to and reflexly dug in the old heels with an
unthinking, "Not in my house, mate"?
The sorry tale of the multiple ill thought-out redisorganisations of
last few years is then rolled out in all its gory glory. You seem to
suggest that from 2002 to 2004 unprecedented progress was made on all
fronts; health inequalities, local needs, parlous Primary Care, dirty
hospitals, staff recruitment, target setting and getting. You present no
evidence for these bold assertions...you certainly didn't ask those of us,
"managing to concentrate on caring for patients despite the surrounding
You claim an end result that provided "a more patient-centred
I nearly gave up reading here; fairy tales and fantasy just don't do it
However, it appears your tale has a sad ending. Despite already
achievements, in 2005 you were requested to, "create a patient-led NHS".
And guess what? The money had run out, the NHS was broken beyond repair
and, despite setting out to halve management costs, possibly the first and
only initiative I would support, you became "disillusioned". Well, welcome
to the real world, grasshopper.
To put it another way, you belatedly discovered you had colluded in
own destruction as well as that of the NHS.
None of us left working in the remains, including the patients, know
will happen next. We suspect it will not be good.
Meanwhile, I wish you well in your transfer to the "large independent
sector healthcare provider" you mention. Excuse me if I am less concerned
with your "exciting and brave career move" than with the mess you leave
Competing interests: No competing interests
This is a surprising Personal View. I suspect most doctors who have
been afflicted by years of institutional revolution in the NHS would be
astonished at the assertion that they are not affected by it, especially
when that assertion comes from one who has connived with it.
If they do not understand the structure of the NHS, it is surely
because it alters so frequently that those at the clinical sharp end have
difficulty keeping track with the latest changes.
The author's description of her work indicates that she was part of
I can sympathise with her decision to leave the NHS because ongoing
upheaval has frequently led to job losses and continues so to do.
Adherence to New Labour in practice does not necessarily pay the bills.
I do hope that the author is enjoying greater fulfilment and
stability in her new post, unlike those left behind in the NHS. No doubt
she will consider the views of those who work in the acute hospitals
Netcare seeks to run (1). I wish her well in preventing the recurrence of
problems such as reported "contract failings over clinical responsibility"
involving Netcare (2),failure to register with the Healthcare Commission
(3), and concerns over prevention of infection (4).
The ongoing privatisation of the National Health Service remains a
cause for concern and we are all very much affected by it, especially
those at the clinical coal face, whether we are doctors or patients.
(1) Hospital Doctor 14 September 2006 http://www.hospital-
(2) Hospital Doctor 3 November 2005 http://www.hospital-
(3) Hospital Doctor 7 July 2005 http://www.hospital-
(4) BBC News Lancashire 1 August 2005
PG has an academic interest in preventing medical error, and, like Dr Wilson, has left the NHS
Competing interests: No competing interests