ABSTRACT
The NHS is the largest employer in Europe. Its complexity incorporates different cultures and values, professional rivalries, incessant change by successive governments with political interference, financial constraints, unequal distribution of power and a top-down management approach. The many and varied components of the NHS pose challenges to change. Devolution of health care within the four nations of the UK means differences exist but without data to enable comparison and make judgments about the success or otherwise of change. Complexity is complicated by the number of professional groups, with different regulatory bodies, identifying values and culture within their professions. While the declared values of the different regulatory bodies are very similar, issues of power and structural hierarchy give rise to challenges in interprofessional working. Large numbers of policy changes, with successive governments imposing structural changes, have at times impacted the ability of health professionals to practise in a way which is compatible with their professional values. Successful change is possible in the NHS, whether it be practice, clinical or organisational change. Change does not need to equate to chaos, it can be better managed through listening to and working with the health professionals who strive daily to improve the nation’s health.
