Intended for healthcare professionals

Views & Reviews If I Ruled the NHS

Fund the service from a hypothecated tax

BMJ 2015; 350 doi: (Published 01 April 2015) Cite this as: BMJ 2015;350:h1483
  1. Henry Marsh, senior consultant neurosurgeon, St George’s Hospital, London
  1. henrymarsh952{at}

The NHS is one of the largest healthcare organisations on the planet, carrying out a bewildering and complex variety of functions. It is therefore folly to think that any one person, or a small group of people, can change it quickly without unleashing an avalanche of unintended consequences that could easily destroy the intended benefits. And yet that is what happened with Ken Clarke and Margaret Thatcher’s introduction of the internal market and with the present and previous government’s reorganisations. It is ironic that innovation in medicine is supposed to progress slowly and cautiously in an evidence …

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