Intended for healthcare professionals


Turning up the heat on the NHS

BMJ 2021; 375 doi: (Published 29 October 2021) Cite this as: BMJ 2021;375:n2618
  1. Nigel Edwards, chief executive
  1. Nuffield Trust, London, UK
  1. nigel.edwards{at}

It hasn’t worked in the past and won’t work now

Recent weeks have seen England’s secretary of state for health become more activist than we have seen for some years. Sajid Javid’s announcements have included the sacking of managers in failing organisations, a review to “shake up” leadership led by a retired general, and instructions to general practitioners about face-to-face appointments with a pledge to “fix” those identified as not delivering.1

These policies seem to be based on a view that the problem is a lack of motivation or competence, and that the solution is a regime of “targets and terror” with naming, shaming, and, in the case of managers, replacement.

Evidence from recent NHS history suggests this diagnosis is wrong and that the treatments will have little benefit and serious side effects.

The secretary of state’s attribution of differences in performance to leadership is based on his observation that some areas with similar funding and demography perform better than others.23 But this ignores many …

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