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Creative destruction in the NHS

31st May 2006

When the prime minister makes two major interventions in the NHS in the space of a week, it is a sure sign that the problems of the NHS have reached the top of the government's agenda says Chris Ham in the BMJ.

In a speech to the New Health Network Clinician Forum, Tony Blair argued that a 'crunch point' had been reached in its reform, emphasising that he and his government intend to hold their nerve and see the process of change through, even if this means bearing the short term political costs.

To many NHS staff Tony Blair's determination to press ahead with reform must seem difficult to comprehend, says Ham. Government policies bear all the marks of the 'creative destruction' that generates growth and change in competitive industries, the incessant process of innovation in capitalist economies, enabling development from within as established companies are threatened and destroyed by new entrants. The aim is to produce a system that will adapt itself to changing circumstances instead of constantly being driven by the government to reform. This implies that the changes to the NHS so far will look like minor skirmishes compared with the bigger battles that lie ahead.

Will ministers then have the courage of their convictions? Or will the forces of creative destruction they have unleashed come back to destroy them, rather than the 'old monolithic NHS' that the prime minister took to task in his speech, asks Ham.

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