Intended for healthcare professionals

Rapid response to:


The “redisorganisation” of the NHS

BMJ 2001; 323 doi: (Published 01 December 2001) Cite this as: BMJ 2001;323:1262

Rapid Response:

the centre is at fault

This brave editorial highlights the unprecedented micromanagement of
the NHS by central government. Statements by the Secretary of State that
Primary Care Trusts and Hospital Trusts will have more freedom are
undemined by the creation of a comples set of structures between Trusts,
where the work is done, and the centre. There will be supraregional
directors of health and social services, Government offices with directors
of public health, 30 Strategic Health Authorities to monitor performance.
public health observatories, a modenisation agency, a development agency,
an information authority, a retained organs commission,, and tsars for a
number of specialties/diseases. (and these are the ones that I have heard

Older observers will note that the structure of the NHS has almost
gone full circle back that of 1948 except that hospital management
committees are now hospital trusts, and local authority health departments
are now primary care truats. The big difference is that instead of 15
regional health authories we now have a highly complex intermediate tier.
About the only good poitn after 50 years is that general practitioners are
now prepared to be more involved with local planning and management.

If there is to be yet another inquiry into NHS management it shoudl
focus on the actions of the "centre". After all it is not clinicians and
managers who have reduced capacity by refusing to allow an adequate number
of beds and opertaing theatres, got staffing numbers wrong, underfunded
socaial servcies departments, failed to ban tobacco advwertising, and
repeatedly reorganised the service over 25 years with major disruptions,
expense, and loss or demotivation of experienced staff

Competing interests: No competing interests

06 December 2001
Gordon Pledger
retired Director of Public Health
Newcastle upon Tyne