Chris Lancelot on...chucking out the rule book

A remarkable experiment has just taken place in Drachten in the Netherlands: they've thrown away their traffic signs.

Gone are the white lines on the roads, the traffic lights and the paraphernalia of street furniture. Amazingly, the number of accidents has fallen, and those that do occur are more minor than before. The death toll has dropped markedly and, most surprisingly of all, the average traffic speed through the town has stayed the same. Why? Because the lack of road instructions means that drivers have to look carefully and think for themselves.

I wonder what would happen if we applied the same thinking to the NHS? By common agreement we are inundated with rules and regulations from a control-freak government. Yet for all the regulations, all the controls, and all the bureaucrats necessary to do the controlling, even Patricia Hewitt has accepted that NHS output hasn’t risen despite the additional annual £48 billion spent on it by New Labour.

So why don’t we try sweeping away the petty restrictions and give every worker in the NHS the freedom to get on with his or her job without bureaucrats and managers snooping on them all the time? The experience of Drachten has shown that although this sounds counterintuitive and dangerous, the reverse is actually the case. Instead of having slavishly to obey regulations, liberated NHS workers would be free to think about their work and act accordingly. In turn this would bring a greater sense of purpose and professionalism, and a feeling of true self-worth even in a large healthcare system.

Once the morass of bureaucracy has been removed there will be more money to send to the sharp end of medicine. Just imagine — no waiting-time targets, so professionals can spend their time treating the sickest patients first; yet the ones at the end of the queue will be seen quickly because all the freed-up money will allow hospitals to buy in large numbers of those health professionals who really count — doctors, nurses, theatre staff, medical secretaries. Contrary to expectations, a bonfire of regulations and a culling of regulators would improve the NHS’s output and standards.

It must have taken guts to initiate the Drachten project, yet it worked. Will our control-freak government have the strength of mind to do the same with the NHS? I doubt it.

- Dr Lancelot is a GP from Lancashire.

Email him at

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