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:

Making it change by leaving it alone

There is no question that there is much wrong in the organisation and
management of the NHS. The government's error is to think that it can
solve the problems with structural change. A lesson I leaned from 9 years
on a hospital board was that it is only possible for management to make
radical changes if the basic environment is stable.In our case some
radical developments took place in the way services were delivered,which
contributed to solving problems of waiting times, responsiveness to
patient needs, and quality of care. These happened with the support of
clinical staff.

There is no perfect stucture. Function is more important than
stucture. The focus should be on making the existing arrangements work.
An important starting point is to learn to leave it alone.

Competing interests: No competing interests

06 December 2001
Charles Normand
Professor of Health Economics
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT