Intended for healthcare professionals

Rapid response to:


Reorganisation of the NHS in England

BMJ 2010; 341 doi: (Published 16 July 2010) Cite this as: BMJ 2010;341:c3843

Rapid Response:

Releasing creativity and innovation is not reorganisation

Am I the only one who thinks the proposed changes to the NHS in
England are a good thing?

Reading Professor Walshe's remarks I am reminded that one reason
governments engage in organisational reform is because the public sector
is virtually immune from customer or user pressures (governments are
usually monopoly suppliers to the public who are in effect offered a take
it or leave it option, regardless how abysmal the service quality) and
virtually deaf to public sector entrepreneurialism. One reason for this is
quite simple: governments must play the long game and this translates into
a perhaps mistaken or overzealous pursuit of stability at the expense of
almost everything else -- in effect the government crowds itself out of
the marketplace of new ideas and innovation.

What we are learning, though, is public services should suffer the
same creative destruction characteristic of the private sector, but there
is by and large little appetite for the creative or otherwise destruction
of publicly funded institutions, which like cherished china ornaments,
never seem to disappear when they are no longer needed (or until a crisis
demands change, such as new financial institutions).

All this has to be broken somehow, such as this White Paper, as
governments are right to worry about the lack of entrepreneurial zeal to
improve publicly funded services.

So someone's got to do it, and governments will and should and must
do this as often as it takes until the right mix of incentives and staff
initiative emerge to create the climate of excellence and innovation that
the public expects from public services. Professor Walshe may need to get
used to a messy healthcare world, full of wicked or complex problems and
many, many different ways of doing things.

I see no contradiction in the coalition government promising no more
top down reform yet doing this. The proposed direction is really about
sweeping away accumulated disincentives and organisational baggage, so
that bottom-up initiative, responsiveness and innovation.

Competing interests:
None declared

Competing interests: No competing interests

22 July 2010
Michael Tremblay
healthcare advisor
TN25 6RJ