From tsar to godfather via the cardiovascular framework

BMJ 2011; 343 doi: (Published 01 August 2011) Cite this as: BMJ 2011;343:d4917
  1. Susan Mayor
  1. 1BMJ

What really makes a difference when it comes to improving outcomes in the NHS? Certainly not wholesale dismantling of systems and processes that are working well or pitting groups of professionals against each other and inviting commercial providers to pitch for services to reduce costs, argues Roger Boyle.

He retired last week after 11 years as England’s national director for heart disease and stroke, because he disagrees so strongly with the coalition government’s plans for the NHS.

“No reorganisation ever saved anybody’s life. The thing that remains the same, year after year and reorganisation after reorganisation, is the clinician, the patient, and the disease, all in a room together. Everything else is secondary to that.

“Whether this is in primary, secondary, or tertiary care, it is this relationship—and how it is dealt with—that is absolutely crucial.”

Professor Boyle acknowledges that NHS care must be cost effective, but he considers that the complete dismantling of NHS structures is unnecessary and won’t help improve efficiency. “I get fed up with people decrying the NHS. We vie with the Netherlands and Scandinavia for having some of the best quality health services in systematic comparisons.

“In terms of value for money, we always come out as being the most efficient, with some of the …

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