Intended for healthcare professionals

Views & Reviews If I Ruled the NHS

Set our talented professionals free

BMJ 2015; 350 doi: (Published 09 April 2015) Cite this as: BMJ 2015;350:h1811
  1. David Berger, district medical officer, emergency medicine, Broome Hospital, Broome, Western Australia, and former UK GP
  1. daveberger{at}

If I ruled the NHS I would trust in its professionals. We’ve tried endless administrative reorganisations (always preceded by a promise to end reorganisations), a hugely damaging process.1 We’ve tried bullying, in the form of naming and shaming. We’ve tried totalitarian control by ever shriller diktat from the centre and politically motivated targets. Each of these targets creates its own set of perverse incentives that in turn fosters its own biosphere of measures, countermeasures, and über-countermeasures. Meanwhile the clinicians on the ground try to do what is right for the patient, while the local and regional managers try to cook the books to satisfy their Whitehall and political bosses, who need a good story to sell …

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