ABSTRACT
One of the paradoxes of the National Health Service (NHS) is that it looks like it is undergoing continual change and yet much stays the same, including the problems the service encounters. You can change structures and procedures, you can encourage, reward and punish, you can shift resources to prioritise different things, you can seek to change the roles or the practice of key groups within the NHS, the professionals who staff it and the managers who seek to run it and yet the same problems persist. Which, if any, change mechanisms work? Perhaps there has been so many attempts to change and yet so many recurring problems because of a reliance on linear solutions in a complex world. Seeking to change culture is quintessentially a complex intervention and power differentials within care policy making, practice settings and as part of culture are not given sufficient attention. The issue of funding levels is revisited and the importance of fostering solidarity and privileging narratives of care is emphasised.
