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The Perils of Industrialised Healthcare

Exploring the limitations of the King's Fund report: “Reforming the NHS from Within”

Author: David Zigmond

The King's Fund's report “Reforming the NHS from Within” questions the wisdom of decades of structural reform within the NHS. The report's author, Professor Chris Ham, argues that a confused cocktail of markets, regulations and targets has detracted from more positive possibilities. He offers a more human account of the kinds of changes that would help strengthen the NHS. But does the King's Fund's critique go far enough?

David Zigmond argues that there are even graver issues to consider. The National Health Service, at its best is about supporting and sustaining thoughtful, caring and knowledgeable relationships between professionals and citizens. But too many managerial initiatives undermine agency and harm relationships. Treating staff like robots, or patients like items on a conveyor belt, is dehumanising and dangerous.

Much more attention needs to be given to the factors that strengthen our relationships:

  • Doing things at a human scale - not progressively more giant
  • Working with trust and flexibility - not meaningless regulations
  • Providing security and freedom - not financial penalties and incentives

Zigmond's work explores the limits of industrialised healthcare and calls for fresh thinking about how to restore and protect the human dimension of the NHS.

“In this paper David Zigmond illuminates the internal factors that ensure the effectiveness of the NHS: relationships of trust, closeness to community, and a human scale. All of these have been sacrificed by those who have imposed phoney competition, privatisation and bureaucratic regulations on the NHS. However, even important allies of the NHS, like the King's Fund, struggle to understand what really matters to the people who use and work in the NHS. Too often we turn people into robots - mere agents of our good intentions. We forget that bigger is not always better.”

Simon Duffy, Director of the Centre for Welfare Reform