There’s a line often attributed to the Roman army:
“The only constant is change.”
If that doesn’t describe the NHS, nothing does.
And during the 1990s, when yet another restructure rolled in, someone in a Birmingham hospital taped a follow-up note to the management accounts department wall: (this was in a time before email – yes ask your historians there was such a time)
“Due to further cuts, the light at the end of the tunnel has been switched off.”
Dark humour, yes — but also a quiet acknowledgement that the NHS experiences more structural churn than almost any other health system on earth.
To understand why the NHS looks the way it does today, and why Birmingham is a perfect case study, we have to go back to the beginning of the internal market era.
