This article, written by Diane Plamping, was first published in the BMJ in 1998, on the 50th anniversary of the NHS, but is still pertinent today.  The NHS  has been the subject of reforms/restructuring etc by numerous governments but many behaviours have not changed. The author claims that the guiding principles of the NHS may be the cause, and argues if guiding principles shape behaviour within the NHS then NHS reform can only be achieved by engaging with and changing these principles.

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