Intended for healthcare professionals

Views & Reviews If I Ruled the NHS

Support doctors who lead change programmes

BMJ 2015; 350 doi: (Published 12 February 2015) Cite this as: BMJ 2015;350:h704
  1. Ruth Carnall, managing partner, Carnall Farrar, and former chief executive, NHS London
  1. ruth.carnall{at}

Everyone agrees that the NHS needs “transformational change” and more “clinical leadership.” Yet to many doctors the processes that purport to support and approve major change consist of a mountain of bureaucracy focused on political risk avoidance. Continually saying, “Yes, we will support this if you can only produce this further proof,” creates more and more hurdles, hindering change. It results in doctors who have led change programmes having to act like circus animals performing meaningless tricks and then being told that their act is not good enough. So in my benign dictatorship I would insist on “yes” meaning “Yes, we …

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