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Improving the performance of the English NHS

BMJ 2010; 340 doi: (Published 07 April 2010) Cite this as: BMJ 2010;340:c1776
  1. Chris Ham, professor of health policy and management
  1. 1Policy and Management, Health Services Management Centre, University of Birmingham, Birmingham B15 2RT
  1. c.j.ham{at}

    Systems of care are needed to build on progress to date

    The NHS in England has been a laboratory for healthcare reform under the Labour government. While much has been achieved during Labour’s stewardship, particularly major reductions in waiting times for treatment and improvements in areas of clinical priority such as cardiac and cancer care, there is a great deal of unfinished business. The agenda for the future includes giving high priority to prevention, shifting care closer to home, and grasping the nettle of acute hospital reconfiguration to reduce duplication and improve outcomes.

    As this agenda is taken forward, a crucial question is: what approach should be used to bring about improvements in performance? Three reports commissioned by the Department of Health during Lord Darzi’s “Next Stage Review” shed light on this question. The reports have recently been released after a Freedom of Information Act request, and they offer important insights into the means used by the government to bring about change in the NHS in England.1 2 3

    Although each report makes specific recommendations in line with its terms of reference, the consistent and recurrent themes in all three are of greatest interest. These themes include the destabilising effects of constant organisational restructuring, the negative consequences of a command and control style of leadership, and the lack of …

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