A short history of NHS leadership reviews

Porritt report, 1962

Sir Arthur Porritt, president of the Royal College of Surgeons, chaired a British Medical Association committee of inquiry into the NHS which suggested that services – at the time split between GPs, local authorities and hospitals – be brought together under a single area board whose chief officer was a doctor.

King’s Fund/Institute of Hospital Administrators joint working party, 1967

This criticised previous reports that had “failed to grasp the nettle that someone had to be in command… with authority over all the rest of the staff”.  It recommended a clear chain of command under a general manager supported by medical and nursing directors.

Cogwheel report, 1967

The so-called “Cogwheel report” encouraged the involvement of clinicians in management, recommending the creation of clinical divisions to ensure efficient use of resources and to cope with management issues in clinical fields.

The Grey Book, 1972

This recommended a system of “consensus management” by multidisciplinary management teams.

Griffiths report, 1983

Roy Griffiths, deputy chair and managing director of Sainsbury’s, found the NHS had no coherent system of management. In the report he famously said: “If Florence Nightingale were carrying her lamp through the NHS today she would be searching for the people in charge.” Key among its recommendations was that general managers be introduced into the NHS and that doctors should become more involved in management. The government’s response to the inquiry accepted the shift from consensus management.

Troubleshooter, 1990

Although not an official review, the successful businessman Sir John Harvey-Jones visited a health authority for the Troubleshooter television series. He encouraged managers to look at problems from the customer’s point of view and said clinicians needed to get more involved with management.

Adair Turner, 2002

Adair Turner, a former director general of the Confederation of British Industry, was tasked by Tony Blair with producing a strategic report on the NHS. The report, which was not published, called for staff to be given greater responsibility, with nurses taking on some tasks performed by GPs and GPs relieving pressure on acute outpatient departments.

Can Gerry Robinson Fix the NHS?, 2007

Reviving the Troubleshooter format, the former Granada chief executive Sir Gerry Robinson attempted to reduce waiting lists at Rotherham General Hospital.

NHS Next Stage Review, 2008

Lord Darzi’s review placed emphasis on clinical leadership, prompting a national leadership council to be established by the NHS chief executive in 2009.

Liberating the NHS, 2010

The newly elected coalition government set out radical plans, which involved handing decision making over local commissioning to GPs. These led to the development of the 2012 Health Act.