Intended for healthcare professionals

Letters Cultural change in the NHS

Transparency and the foundations of the health service

BMJ 2013; 346 doi: (Published 25 April 2013) Cite this as: BMJ 2013;346:f2507
  1. J T Elliott, retired consultant psychiatrist1
  1. 1Whitworth, Rochdale OL12 8LT, UK
  1. jjtelliott{at}

The NHS was founded to provide, in the interest of patients, the best care as near to their homes as possible.

Hospital management committees—local worthies and councillors, a public health adviser, and members experienced in nursing and general practice—supported and supervised this provision. Senior hospital executives—medical superintendent, matron, and secretary—attended meetings. Members of the management committee visited all wards and departments of the hospital regularly and spoke to patients and staff. Local transparency was inevitable and accountability implicit.

The present “trust” system of management is …

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