Intended for healthcare professionals

Rapid response to:

Analysis And Comment NHS reorganisation

Who's kicking who?

BMJ 2006; 333 doi: (Published 21 September 2006) Cite this as: BMJ 2006;333:645

Rapid Response:

NHS is not short for National Health Service

Nigel Hawkes’ description of English healthcare is uncannily
accurate: painfully so for those of us that have given much of our time
(the best years of our lives?) to supporting the “New NHS”; for which, now
read the “Old NHS”. He is right to identify the “Kicking Hierarchy” as
being important.

I have often wondered how it is that we are all so proud of the
“National Health Service” – as we tell people that we meet on our foreign
holidays – but that we complain endlessly about the “NHS”. Are they not
the same: the “National Health Service” and the “NHS”? I would argue that
they are not.

The National Health Service (although invented by a far-sighted
politician) is a much-loved collaboration between Patients, the Public,
Doctors, Nurses and the UK Government. Like the British Constitution, or a
well-functioning family, it works without very much being written down. It
is immensely powerful – any government that was seen to threaten it would
be doomed – but the power exists only because people care for it.

The NHS is an administrative agency of the government that exists to
ensure that the money collected by the government for the National Health
Service is spent well. Unlike the National Health Service itself, the NHS
is prone to being officious, bureaucratic, over-controlling and frequently
just a pain. The NHS is meant to be a supporting structure and, at its
best, it can do this very well. Even so, the NHS is relatively weak, and
trembles at the sight of government ministers – just as government
ministers tremble at the sight of the National Health Service.

So here we have the true hierarchy. The National Health Service kicks
the Government and the Government kicks the NHS. So next time you get an
unintelligible letter with the NHS logo on it, remember that it has come
from one of your servants.

Competing interests:
I was PEC Chair of South Leeds PCT for three years.

Competing interests: No competing interests

27 September 2006
Daniel J Albert
South Leeds PCT Medical Service Leeds LS10 4HT