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NHS leaders are failing to “speak truth unto power”

BMJ 2017; 356 doi: (Published 19 January 2017) Cite this as: BMJ 2017;356:j256
  1. David Lock, chair, Innovation Birmingham, barrister, and member, BMA Medical Ethics Committee
  1. DLock{at}

Promises to deliver the impossible are endemic in NHS management culture, says David Lock

This article started as an expression of serious frustration at the way the NHS is run and at some senior NHS managers’ willingness to become complicit in something near to dishonesty. Then, against the backdrop of a winter crisis in the NHS,1 the mood changed, and it became prescient. We saw Simon Stevens start to admit that the NHS was underfunded by political decision makers and was, in effect, being asked to deliver the impossible.2

Everyone at the front line of care knows that the NHS is running on empty. The more perceptive know that more money for the NHS will not by itself improve services for patients. But—and this is perhaps the unpopular “but”—NHS senior managers ought to accept their share of the responsibility for …

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