Intended for healthcare professionals


Bury the bill

BMJ 2011; 342 doi: (Published 26 June 2011) Cite this as: BMJ 2011;342:d4050

Too late to save the NHS?

I applaud the clear stance taken by the BMJ on this issue. However, I fear it may have come too late to save the NHS as we know it.

Over the past 18 months there have been substantial management cuts in many primary care trusts and strategic health authorities across the country. For many smaller primary care trusts, they will have lost any economy of scale in terms of management capacity to be effective or efficient. Scaling them back up will take time, and considerable expertise and organisational memory will have been lost in the recent management cuts. So in the meantime we are stuck in limbo, in the middle of a tight rope, trying to figure out whether to go forward towards the untested and uncertain clinical commissioning groups model, or back to the familiar old health structures.

However, the proposed health sector reforms is only a smokescreen for a far bigger problem - that is the demographic change we as a country are experiencing in the context of financial and resource constraints. This government has sidestepped its one essential responsibility in determining what services can be afforded and provided for by the state. Instead, they have tried to 'pass the buck' on to clinicians for what will ultimately be an unpopular and unpalatable decision to ration further health services if no new monies are found.

This is by no means the end of the story yet.

Competing interests: No competing interests

01 July 2011
Andrew CK Lee
Senior Clinical University Teacher in Public Health
ScHARR, The University of Sheffield