ABSTRACT
In 2009, David Cameron, the leader of the British Conservative Party in opposition, gave a speech to the Royal College of Nursing. He promised ‘no more pointless top down reorganization of the National Health Service' (NHS). The American health policy leader Don Berwick commented ‘In good faith and with sound logic, the leaders of the NHS and government have sorted and resorted local, regional, and national structures into a continual parade of new aggregates and agencies. Given its size, the NHS functions not as a single group but as a web of interdependent systems connected by a meta-matrix of connections formed through historical and cultural links – groups within groups. Constant reorganizations, which successive governments have engaged in, fracture relationships and the fragile ecosystem which keeps very large systems functioning.
