Observations Life and death

Something rotten

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39367.395694.4E (Published 25 October 2007) Cite this as: BMJ 2007;335:855
  1. Iona Heath, general practitioner, London
  1. iona.heath{at}dsl.pipex.com

    Money is the driver of NHS change but it is warping minds and corrupting both individuals and institutions

    There is something rotten in the state and stewardship of the National Health Service and it has to do with the ascendancy of money. I once heard an influential health economist claim that the only valid motivation of human behaviour was the pursuit of money. This was greeted with derision by the nurses in the audience, who thought that their entire choice of career was in itself proof of the falseness of his preposterous but profoundly depressing claim. However, the introduction of payment for performance through the Quality and Outcomes Framework of the current contract for UK general practitioners demonstrates that money does indeed motivate significant changes in behaviour—or, at least, in the recording of behaviour. But if money is thought to be the only motivation, hugely important human aspirations are systematically marginalised and our conception of what it is to be human and a member of society is diminished.

    It is fashionable for politicians and journalists to portray doctors as self serving but, if this is genuinely perceived to be a problem, we must ask why the current contract has removed almost all the safeguards …

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