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:

If managers don't take on change then the government will

I read with interest the article by Smith & colleagues. I do not
agree with their assertion that the changes are the least debated. The
language of 'quality' has been the currency of the NHS debate for the past
25 years, and the current transformations are but the latest chapter.
Managers are acutely aware that this perpetual, ongoing and very public
dialogue will result in changes in the definition of 'quality'.
Consequently, they also know that this will cause inevitable systematic
changes in the way they work. This is the very nature of modern NHS

I further think that it is a little simplistic and unfair to state
that this government has never trusted or valued NHS managers. It may be
more accurate to say that the government knows that there will always be
an element of covert resistence to imposed political solutions amongst
some of its NHS managers. I am sure that those who have worked in NHS
management are able to recall acts of policy sabotage both at authority
and regional level.

Sadly, many of these political solutions are no more than knee-jerk
retorts to NHS failings in 'quality' and this can undoubtedly be
frustrating and unsettling for managers. However, if managers do not lead
and facilitate these reponses then the government will continue to do so.

Competing interests: No competing interests

30 November 2001
Paul McDonald
senior lecturer (research)
university college worcester wr2 6aj