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Views & Reviews

Doctors must lead efforts to reduce waste and variation in practice

BMJ 2013; 346 doi: (Published 06 June 2013) Cite this as: BMJ 2013;346:f3668
  1. Chris Ham, chief executive, King’s Fund, London W1G 0AN, UK
  1. C.Ham{at}

US healthcare organisations show that leadership by doctors is essential in tackling the pressure of further financial cuts and to halt the decline in performance if the NHS model is to survive, says the King’s Fund chief, Chris Ham

The King’s Fund’s latest survey of NHS performance in England paints a picture of a service struggling to cope with increasing demands at a time of unprecedented resource constraint.1 2 The pressures on the NHS are greatest at the front doors of hospitals, with waiting times in emergency departments the longest they have been in a decade. The prime minister’s pledge to maintain the commitment to treat 95% of patients within four hours in emergency departments was broken in the first quarter of 2013, a clear and worrying signal of what lies ahead.

With public spending under renewed scrutiny as the chancellor concludes the spending review for 2015-6, there is little prospect that more money can be found to deal with these pressures. Indeed, with press reports suggesting that some of the supposedly ring fenced NHS budget may be taken to support hard pressed social care services, health service leaders will …

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