Dr David Zigmond Home Page
Photo by Ruskin Kyle
Location and vocation – some grand entrances: St James Church
(Home to the author's NHS surgery for nearly three decades)
to use this website:
some navigational aids
How to use this website:
some navigational aids
This website has grown
to offer a large amount of material: more than forty years of articles,
together with more recent open letters, interviews and brief videos.
It is arranged like a large traditional library, so it needs a guiding map and
The following suggestions and
table of contents may help you find what most interests you more quickly and
· The videos
are separately and clearly designated. Likewise radio podcasts.
The articles are
generally longer pieces, with more human description and discursive analysis.
They are found in Section L and
are chronologically listed with the year of writing, together with a
The letters are
generally shorter and more polemical, though with some clear exceptions. They
are found in Section K, similarly listed, with dates and
sections are much smaller and clearly designated. All have links via the Table
interviews are grouped in Section M.
A small number of
writings are found in more than one section: this is done in the interest of
accessibility. In particular Section G clusters the articles and
correspondence pertaining to a contentious decision taken by governing
authorities in 2016. This section thus serves as a documented and dissected
study of a particular struggle of values: how to deliver personal healthcare
within an industrially managed system. Because this kind of problem is coming
to be seen as a serious fault more generally, throughout our Welfare services, it probably merits this
The length of
articles, interviews and longer letters is indicated to help match readers'
choice and appetite.
· Reviews of books and films are symbolised by or .
· Some articles detail and thematise the history of
changes witnessed by the author, as shown in the human aspects of our
healthcare. These are symbolised by Time
Some of the contents
of this Home Page can also be found on other publications’ websites, eg the Centre for Welfare Reform, Open
Medical Journal, British Journal of General Practice, Journal of
Holistic Healthcare, Doctors for the NHS, and YouTube.
with concise navigation
Table of contents
Author's note and acknowledgements
the writings of David Zigmond, Professor André Tylee:
Introduction to the
writings of David Zigmond - Part 1 2010. A black sheep in herded healthcare.
Introduction to the
writings of David Zigmond - Part 2
2017. Neither ‘tongue-tied or twisted but an earthbound misfit’.
Obituary: St James Church Surgery 1987-2016
The Family Doctor and the
Grid by Dr William House
What is the British
Holistic Medical Association?
Contention with NHS
England and the Care Quality Commission
David Zigmond’s books and
Author's note and acknowledgements
Author's note and acknowledgements
Introduction to the
writings of David Zigmond by Professor André Tylee
Introduction to the writings of David Zigmond - Part 1 2010. A black sheep in herded healthcare.
Introduction to the writings of David Zigmond - Part 2 2017. Neither ‘tongue-tied or twisted but an earthbound misfit’.
Obituary: St James
Church Surgery 1987-2016
James Church Surgery 1987-2016
The Family Doctor
and the Grid by Dr William House
The Family Doctor and the Grid
What is the British
Holistic Medical Association?
What is the
British Holistic Medical Association?
G. Contention with NHS England and the Care Quality
Contention with NHS England and the Care Quality
H. David Zigmond's
books and reviews
David Zigmond's new book:
If you want good personal
healthcare - see a Vet: Industrialised Humanity: Why and how we should
care for one another?
Further information about
David Zigmond's books
Book Review by Pulse
Review for Doctors for the NHS Review from British Journal of General Practice
Dr Zigmond, founder member of BHMA, GP, psychiatrist and
author, has published the anthology of his writings. Meet him in the videos
below, speaking at the London launch of his books held at the Royal Society of
Medicine in October 2015.
Short version of video (2
Long version of video (12 mins)
Centre for Welfare Reform videos:
C. Talk to University of the Third Age: 2nd July 2018
Radio podcast interview 1: 6 October 2016.
The coerced closure of a much-loved small
traditional general practice: early experiences and reflections.
Radio podcast interview 2: 19 January 2017
The managed loss of personal medical services: later and
K. Letters, chronologised
 Commercial outsourcing of complex welfare work: time for a reversal
Letter to The Guardian,March 2019
 Professional autonomy? Our losses are wide and deep
Letter to BMJ, March 2019
 If we want more professional autonomy we must first
restore trust and relationships in our profession
Published by the BMJ, February 2019
 Family doctors are more than GPs
Blog to BMJ, February 2019
 Our NHS needs more than cash, systems
Blog to BMJ, January 2019
Published in Open Democracy, February 2019
 The CQC’s failures and follies. How far can we blame its senior officers?
Blog to Caring Times, November 2018
 Playing the ball not the player. The CQC as Zeitgeist: an alternative view
Letter to the Caring Times, October 2018
 Personal Continuity of Care: The imperilled crux of our mental health services
Letter to the Secretary of State for Health and Social Care, October 2018
 How may
disciplining authorities best be dialogic? Should governance have limits in
 Is more regulation, management
and inspection always better? What hope for 2019?
Letter to Deputy Director, Care Quality
Commission, October 2018
Letter to senior NHS Executive and colleagues, October 2018
healthcare: how do we replant our human sense? A response to
a King’s Fund report
Letter to Chief Executive of the King’s Fund, August 2018
Industrialised healthcare: how do we replant our human sense? An introduction
Letter to NHS colleagues and senior executives, August 2018
 Collateral damage: the policed industrialisation of healthcare. A personal and professional recent history
Letter to senior officers of NHS England and the Care Quality Commission, July 2018
 We cannot get our best integrated healthcare via competitive corporatism
Letter to The Times, July 2018
 Good medicine needs good personal relationships
Letter to Daily Telegraph, June 2018
 Can robots be good doctors?
Letter to The Guardian, June 2018
 Importing doctors may help us … for a while
Letter to The Telegraph, June 2018
 Psychiatry: Science or Scientism? The inevitability of overdiagnosis
Letter to BMJ, June 2018
healthcare often needs a very different approach from our treatment or
Letter to Chief Medical Officer, England. June 2018
 Industrialised humanity: how may we best
care for one another? An exploratory interview
to colleagues, May 2018
 The target culture rarely benefits complex
to The Guardian, May 2018
 Our failing GP services need human sense as
much as money
Letter to Metro, March 2018
 The more regulations, the less intelligent
Letter to The Times, February 2018
 Safeguarding and the CQC
Letter to The Social Care Workforce, February 2018
 Medical neglect at Liverpool prison: what
can we expect from marketised healthcare?
Letter to The Guardian, December 2017
 Goals and targets are rarely the best way to
a better society
Letter to Daily Mail, December 2017
 NHS growing staffing problems: what about
the rot and wastage?
Letter to The Independent, December 2017
 Is more professional regulation always
Letter to welfare worker colleagues, December 2017
 GPs to humanely contain or guide our encrypted distress?
We have much to retrieve. An historical view.
Letter to Journal of Holistic Healthcare, December 2017
 How do we avoid a grim future for General
A message from Doctors for the NHS, December 2017
 Yet more NHS data, but where is our human
Letter to The Telegraph, November 2017
 Our crisis in General Practice will need
much more than money
Letter to The Times, October 2017
 Our gaping, gasping health service.
Governance v dissidence. How best to compromise? When best to submit?
Letter to NHS colleagues and managers, October 2017
 ‘Care Navigators’? So what happened to
Letter to the Daily Mail, September 2017
 Modern Slavery: how do we separate expedient
economy from our human nature?
Letter to Evening Standard, September 2017
 Our NHS follies and conundrums. Are you
distressed? Perplexed? Recent history has
much to teach us,
Letter to NHS colleagues and managers,
 Vocation or corporation? Competence or
compliance? The managed asphyxiation of healthcare morale
Letter to NHS colleagues, June 2017
 The NHS needs human sense as
much as money and systems
Letter to The Guardian, May 2017
 Government may like giant GP practices, but what about
the rest of us?
Letter to The Sun, March 2017
 Revitalising the NHS? Get rid of the Internal Market
Letter to The Guardian, February 2017
Our oppressive Care Quality Commission: our depressed NHS
Letter to Academy of Fabulous NHS Stuff, February 2017
‘Stakeholders’ in suicide prevention: isn’t that all of
Letter to Chair, Parliamentary Health Select Committee, February 2017
Prevention of Suicide. The crux of personal continuity of
Letter to Chair, Parliamentary Health Select Committee, January 2017
Also published in British Journal of
General Practice, 16.3.17
Dying with, or from, dementia? An important distinction
Letter to The Telegraph, December 2016
BMJ Blog, January 2017
 Older people often need a different kind of hospital
Letter to The Telegraph, December 2016
 Our ailing profession: our consequent fractious collegial
Published in British Journal of General
Practice, 2016 66(653):622-623
 CQC Inspection and closure of my NHS General Practice. Farewell from a long career
Letter to Chief Medical Inspector of Care Quality Commission, November 2016
 Price and value in personal care: the planned closure of
Letter to The Telegraph, October 2016
 Our burgeoning NHS problems are more organisational than
Letter to The Observer, September 2016
 The doctor is out, but still answering
Letter to The Observer, September 2016
 How and why do we retire? Ill omens for younger doctors
BMJ Blog, September 2016
The triumph of the procedural over the
personal. My retirement from NHS General Practice
Letter to NHS colleagues, July 2016
 Only personally fulfilled practitioners can deliver good
Interview with Independent Age, May 2016
 General Practice needs more than recruits and money: we
need to refind our vocational attachments
Letter to The Telegraph, April 2016
 Plummeting morale of junior doctors: one
branch of our blighted tree of Welfare
Letter to the Chair of the Academy of Medical Royal Colleges,2016
 Can we reduce childhood Sepsis by more vigilant
management? I doubt it
BMJ Blog, February 2016
GPs’ demoralisation is due to our loss of
Letter to the BMJ, February 2016
 Our demoralised and depersonalised NHS workforce
Letter to Chair of the Parliamentary Health Committee, February 2016
 How to make our NHS sustainable? We are losing personal
morale and commitment faster than money (re cross-party review)
Letter to Shadow Secretary of State for Health, February 2016
 ‘Airline levels of safety in healthcare’? No, we can't
Letter to The Telegraph, February 2016
 How to make our NHS sustainable? We are losing personal
morale and commitment faster than money:
Letter to ex Health Ministers, January 2016
 Flood defences? It is we that need containing
Letter to The Independent, January 2016
 An electronic questionnaire is far from a personal
dialogue: Further reflections on professional Appraisals
 Arguments about money are often about much else
BMJ Blog, November 2015
 Competence or Compliance? The corrosive cost of
professional practitioner Appraisals
BMJ Blog, September 2015
 Burgeoning need: collapsing staff morale – the management
conundrums of the NHS
Submission to the Secretary of State for Health, 2015
 ‘Curing Dementia’: Medical possibility or political
Letter on BMJ Blog, May 2015
 In public service we need personal integrity, not
Letter to The Telegraph, April 2015
 The Extinction of Care by Treatment: Our healthcare’s
Letter to BMJ, February 2015
 The loss of personal containment in pastoral healthcare
Letter to mental health commissioners,
managers and senior practitioners, 2015
 NHS Stewardship: the missing personal factor
Letter to the BMJ, 2014
 Reclaiming the NHS: Let’s discard the entire Internal
Letter to The Guardian, 2014
 Repealing the Health and Social Care Act: why stop there?
Letter to Andy Burnham, Shadow Secretary of State for Health, 2014
 The death of Robin Williams: can we ‘treat’ our tragic paradoxes?
BMJ Blog, August 2014
 Depression needs more than formulaic treatment
BMJ Blog, July 2014
 Personal continuity of care in Mental Health Services
Letter to Minister of State for Care and
Support. May, 2014
 Personal continuity of care in hospitals. Restoring the
role of the General Physician
Letter to Secretary of State for Health. January, 2014
 Thank goodness we now have business-sense to safeguard
Letter in The Independent, January 2014
 Form devouring essence: When brokered services tend broken hearts
Letter to Mental Health Colleagues and
Managers, January 2014
 Dementia is not only (or even) a disease: it is a signal
of our community cohesion
Letter in The Telegraph, December 2013
 We need an appointment with Dr Finlay
Letter on BMJ blog, December 2013
 Qualifications may be less than useful
Letter to The Independent, 2013
 Dr Frankenstein’s Reprise: Industrialisation of Personal
Healthcare. Adverse effects of sequestered psychiatric in-patient services
An open letter to Medical Directors of
services, October 2013
 Loneliness in the ailing elderly: social and healthcare
Letter to Secretary of State for Health, 2013
 Re-establishing personal bonds and understandings in NHS
Letter to Secretary of State for Health, October 2013
 NHS Healthchecks: more automation and less intelligence
Letter to The Times, 2013
 Psychiatry? Everyone is right - but not for long
Letter to The Guardian, 2013
 The high price of commodified healthcare
Letter in The Guardian, August 2013
 How Care Pathways obliterate care: More industrial
follies from the NHS
Letter in The Telegraph, July 2013
 NHS Savings? Abolish the Internal Market
Letter in The Guardian, July 2013
 Physis: healing, growth and the hub of personal
continuity of care
A thirty-nine (39) year delayed follow-up
correspondence with Sally, June 2013
 The rise of business culture in the NHS; our consequent
loss of compassionate healthcare ethos
Letter to The Times, 2013
 'Fixing the NHS is straightforward'. Really?
Letter in the BMJ, March 2013
 Balancing healthcare: Technical vs Personal. Local vs
Systemic. Closures at Lewisham Hospital
Letter to Joan Ruddock MP and Lord Ara
Darzi, February 2013
 Continuity of care: of course, but whose? A Sleight of Slogans
Letter to Family Doctor Association, 2012
 ‘Evidence’ is both more and less than it seems. The rise
of scientism and the demise of the personal in healthcare
Letter to the Secretary of State for Health,
 Eric: Another victim of Hypertrophic Obstructive
A letter to the Medical Director, South
London and Maudsley NHS Trust, June 2012
 Further NHS Reforms: inevitable and unintended
Letter to BMJ, May 2012
 Commodification, commissioning and commercialisation: the
growing threats to personal healthcare
Letter to the Secretary of State for Health,
 Five Executive Follies
How commodification imperils compassion in personal healthcare
Submission to Secretary of State for Health,
An open letter to Mental Health Services Director,
L. Articles, chronologised
 The Medical Model—its
Limitations and Alternatives (1976)
it says in the title! Uses the example of an ailing, elderly man struggling
with later-life changes. The biomechanical can only take us so far: after that
we need a certain kind of imagination. What is that?
 Suicide and Attempted Suicide:
Its Origin and Course (1977)
kinds of mental illness and self-harm are most easily designated. But what
about more subtle forms of self-damage and self-sabotage? What are they?
 Out of Sight But Not Out of
who professionally care for others are often much harsher with themselves.
Overall, doctors have higher suicide risks than their patients. Why?
 Scientific Psychiatry:
Progress or Regress? (1977)
and Psychiatry operate from a premise of taking responsibility and defining
reality for others. What are the implications for those who need to reclaim
these capacities, for themselves?
 Illness as Strategy and
is often best understood and approached beyond the biomechanical. Experiences
or conflicts not otherwise manageable can find a refuge and conduit in illness.
How and why?
 Adjustment or change?
Radical issues in psychiatry (1978)
mental distress is designated in a way that further ‘pathologises’ and
stigmatises the sufferer. How may we, rather, reframe our problems in ways that
are self-realising and empowering?
 The Elements of
short survey written for Doctors. How may thinking and talking with another
person help the harmony of body, mind and relationships? How to start and when
 Transactional Analysis in
Medical Practice: Part 1 (1981)
clear and flexible model helping us understand the different parts of ourselves
and others. How are these related to our unique stories, and then our patterns
of concord or discord?
 Transactional Analysis in
Medical Practice: Part 2 (1982)
continuation of Part I. How are so many repetitive unhelpful patterns set up in
childhood, to last a lifetime? If we can understand, when is this helpful in
 A Psychosomatic Approach (1982)
by expanding the biomechanical approach into a more multifaceted holism, can we
broaden and deepen understanding and engagement with individuals?
 The Psychosomatic Mosaic (1982)
further coaxing of the biomechanical into a broader holism. How can individual
illnesses be encountered and understood in family systems?
 Mother, Magic or Medicine?
The Psychology of the Placebo (1984)
are fascinating phenomena of induced interpersonal healing, sometimes by
accident! How does this happen? What are the developmental and transactional
psychological theories that can explain?
 Physician Heal Thyself: The
Paradox of the Wounded Healer (1984)
are the personal vulnerabilities of doctors? How are these related not only to
individual wounds, but to idealised roles and depersonalised trainings?
 Babel or Bible?Order, Chaos
and Creativity in Psychotherapy (1986)
of mind are only ever ‘good-enough’, for now. What happens when
psychotherapists (and others) elevate their theories to a realm of Immaculate
 Three Types of Encounter in
the Healing Arts:
Dialogue, Dialectic and Didacticism (1987)
language and understanding are all human activities and constructions. What are
the different types when we encounter others? How do we then ‘pack’ or ‘unpack’
the experience of these others? How, when and why does it matter?
 The Psychoecology of Gladys
people often want skilful, if ritualised, human contact. What happens if we
unimaginatively and excessively medicalise this? Gladys, in the 1980s,
 The Front Door of
Aspects from General Medical Practice (1989)
communicative skills - enabling others to heal, grow and become more resilient
- have been distilled and documented, especially by psychotherapists. What
happens in other venues with these kinds of complex exchanges? How is this
enacted in General Practice?
Shadow of Venus: Atavism and Sexuality (1995)
sexuality is one of the more tragi-comic deciders of destiny. Can an understanding
of our evolution, as a species and as individuals, explain why?
 Edward: shot in his own
interest. Technototalitarianism and the fragility of the therapeutic dance (2005)
have become accustomed to almost everything being prepacked, containerised and
computer-coded. This has happened to knowledge. What happens to personal
 Planning, Reform and the
need for Live, Human Sacrifices: Homogeny and Hegemony as
Symbols of Progress (2006)
are the hidden psychological currents that may lie behind zealous attempts to
‘modernise’ and standardise? Some motives may be obscured and dark. How are
 Modern Times: True Parables from the Frontline
of the NHS (2007/2017)
Change is often called ‘progress’. Looking at changes in
healthcare, this considers two themes: ‘Imagination’ and ‘Belonging’. When is
in Journal of Holistic Healthcare, vol 14, Issue 2, Summer 2017
 No Country for Old Men:
The Rise of Managerialism and the New Cultural Vacuum (2009)
more we control, the less free we are to explore. If we increase the culture of
management, what happens to the spirit of enquiry? And patient care? A
 Psychiatry: Love's Labour's
The pursuit of The Plan and the eclipse of the personal (2010)
psychiatric and psychological healthcare, personal attachments and investments
in therapeutic work have been eclipsed by ‘objective’ attempts at management.
What has this been like for patients and staff? A thirty-five year spanned
 Why Would Anyone Use an
Unproven Therapy? Treasures in the Mist (2010)
of the most effective work healthcare workers do is inexplicit and
undesignated. What does it, then, consist of? The Wizard of Oz has much
to tell us.
 Idiomorphism: the Lost
Continent How diagnosis displaces personal understanding (2011)
is a professional convention enabling us to cluster and code. Sometimes it is
essential and crucial to help. At other times more is lost than gained. What?
 Resolved or Abandoned?Irresponsibly
lost Transference: a professionally embarrassed tale (2011)
increasingly talk of managed and schematised personal change, but often the
catalysts are serendipitous. What can happen?
 Sense and Sensibility: The
danger of Specialisms to holistic, psychological care (2011)
Few would want an operation done by a non-specialist. So
is specialisation always a good thing, with every kind of distress? Can we go
too far? What happens then?
 How to help Harry - Friend
or Foe? The scientific and the scientistic in the fog of the frontline (2012)
Helping others to change can be a very delicate dance.
Attempts at ‘civic engineering’ frequently miss nuances of meaning and
opportunity. Does this matter? Why?
in Journal of Holistic Healthcare, vol 14, Issue 3, Autumn 2017
 Eric - diagnosis may sometimes
be necessary; it is rarely sufficient (2012)
Centralised planning and control are key to the success
of many healthcare initiatives, for example the containment of dangerous
infectious diseases. But what are the limits of this approach? Eric shows us
what can happen in mental healthcare.
 Fallacies in Blunderland:
Overschematic overmanagement: perverse healthcare (2012)
Competition, commissioning, contracting ... do such
devices really ‘drive up’ the quality of healthcare? Are there other, absurd
and darker consequences? What are these?
 From Family to Factory: The
dying ethos of personal healthcare (2012)
NHS healthcare has transformed looser, informal,
colleagueial networks of care into tighter, sharper, more managed ‘production
units'. We have turned families into factories. What have we lost?
 Understanding the Other:
Four elemental questions for therapeutic psychology. A personal view (2012)
attempting to understand and help the anguish of another, what kind of
knowledge helps us most? What lies behind and beyond designated systems? Can
one have a ‘holistic psychology'?
 Words and Numbers: Servants
or Masters? Caveats for holistic healthcare Part 1 (2012)
fuller engagement with realities is an aspiration and ideal. It can never be
complete, and in practice, there are many obstructions. These range from our
use of language to our highly managed and industrialised culture. How does this
happen? What are the consequences? This is the first of two articles.
 If you want good personal
healthcare, see a Vet. Caveats for holistic healthcare Part II (2012)
over-explicit and over-schematic can block our perception of larger and more
subtle realities. This second of two articles portrays how this happens, and
what we may be left with.
 Democratic Fatigue:
information overload (2012)
increasing choice and information always what we want? Do these necessarily
facilitate democratic sense and empowerment? The non-participation in recent
Police Commissioner elections suggests otherwise. Parallels in healthcare are
 Missed and
Miscommunications: Personal disconnections in
Psychological Healthcare. A letter for embattled
our most important, difficult and intimate relationships we must be able to
listen carefully to what we do not want to hear - without this much is
jeopardised. This is true, too, in many of our healing encounters - often these
require our best attempts to creatively contain dissonance.
 PsychoTapas (2013)
Sound-bite seminars for modern conferences!
 Institutional atrocities:
The malign vacuum from industrialised healthcare (2013)
neglect or abuse in our care of the vulnerable within our advanced Welfare
State seems shockingly perverse. How and why does this happen?
 Beyond Orwell: Healthcare’s
hollow governance (2013)
smallest difficulties with others are often rich in political complexity. What
does this mean? Two apparently trivial examples from healthcare administration
 Language is not just data:
it is a custodian of our humanity (2013)
and informatics have become central to NHS healthcare. All experience and
activity are now subject to official technical designations. This changes our
communications: language becomes increasingly lackeyed to the computer’s
requirements. Much else is lost. What?
 Post Mid Staffs: A Plenitude
of Platitudes (2013)
the harmful excesses of depersonalisation in healthcare be usefully addressed
by further redesign of systems and management? Or do we need a different kind
of thinking and vocabulary?
 'GPs know their patients,
families and communities' - Really? (2013)
are increasingly employed as task-directed, upper-echelon healthdroids. They
are losing the pastoral skills that depend on holistic views and vernacular
understandings. Why is that?
 Hello, Health Commissioner.
Goodbye, Family Doctor? The new healthcare reforms
and their threat to personal doctoring. (2013)
idea, now diktat, that GPs should lead the complex provision of healthcare for
localities may subtract more than it adds to overall health-welfare. How and
why could this happen?
is Therapy; All is Diagnosis. Unmapped and perishing latitudes of healthcare (2013)
in medical science have often subtly and inadvertently subverted human
connections and understandings. Vignettes spanning sixty years show how and
 Our Ill-faring Welfare. The
hinterland of our headlines (2013)
ever-increasing funding and management initiatives, our public welfare services
seem riddled with unhappiness, corruption and sometimes cruelty. These are
alarming paradoxes: how do we understand them?
 Bingo! Majoritarian
Accountability and Democracy can seem like a protective triumvirate for public
decision making, but these can easily turn shallow, demotic and false. Here is
a small example of what is coming.
 Where in the World are You? Miraculous
cyber; insidious dislocation (2013)
do mobile communications, Internet sex and modern schematised health systems
have in common? – a computer mediated disconnection of intended content from
embedding human context. What happens?
 Form Devouring Essence: When
brokered services tend broken hearts (2014)
healthcare rhetoric of data and systems has largely destroyed our capacity to
make the kind of personal bonds that understand and heal human dissonance.
Stephen and his plight serve to illustrate and explore this.
 Autoasphyxiation: The doomed
brief of GP Clinical Commissioning Groups (2014)
corralling of GPs to design and commission health services cannot counter the
inherent disintegration and depersonalisation of Marketisation. A glimpse from
 Some Countercultural Caveats
for Pastoral Healthcare – the fractious coexistence of packaged care and
therapeutic spirit (2014)
healthcare has a crisis of competence, morale and humanity. This currently
eludes enormous funds and myriad think-tanks. The elusions are subtle. What are
in NHS Healthcare? (2014)
have turned families into factories.
 Packaged Mindfulness? Some
unpackaged pieces of mind. Can our integrity and wisdom thrive with
increasing push-buttoned and systems-managed world has produced myriad losses
of human relationship and personal sentience. Can this then be countered by
modern packaging of ancient wisdom and practices? Is this our wisest approach?
 A day in the life (2014)
Overboard! A brief autobiographical cross-section
 NHS England 2014: Vichy
France 1941: The old ghosts in our new NHS machine
prescribed schemes to increase democratic accountability in Welfare are easy to
intend, yet very difficult to implement. They can easily backfire to
unanticipated forms of oligarchy or totalitarianism. How does this happen?
 Our unravelling humanity: do
we need more regulations? (2014)
its credit the government seems to now be understanding the importance of lost
human connections. The response, though, is predictable: it is to add to
Healthcare’s already massive regulation. This may add rather more to our
 PBR, PBC, PCT, CCG, CMHT,
CBT, NICE, QUOF: NHS Alphabetti spaghetti? A guide for the perplexed: a
critical glossary (2014)
do the plethora of NHS institutional terms mean? Why are they important to
understand? And what is their relationship to one another? Can this help
explain our current malaise in healthcare? Here is a critical glossary.
 Mass-produced Mindfulness
for Common Mental Health Problems: The awkward dance between managed systems
and human meaning (2014)
greater and calmer sentience is key to much of our better health and
life-experiences. Can we mass-produce methods to achieve this?
 Our Welfare is ill-fared by
yet more strictures and structures (2014)
all Welfare professionals should forever be more strictly appraised and
registered? Here are some reasons why not.
 Six Suicides and One
Homicide. The catastrophe of jettisoned personal containment in healthcare (2015)
and treatment are different though synergistic. The increasing trend to
executise treatment over care destroys this critical complementarity. The
consequences show us how important are such balances.
 Healthcare's Hole in the
Heart : Can we have value for money and not lose our humanity (2015)
Efficiency has now become cardinal in healthcare
management. Increasingly methods from competitive production industries have
been adopted. Yet the results are often paradoxical and demotivating. Why is
 Appraisals: how do we assure
safety without asphyxiation? (2015)
‘We can’t carry on like this!’ is now a familiar cry of impotent frustration
throughout Welfare services. Clearly we need challenges to our dysfunctional
order. Yet our officials’ responses are often redolent of the last gasps of
Empire: draconian authority with officious nervousness. What is happening?
This example – of General Practitioner Appraisals – is a telling microcosm.
 A Fortunate Man: the
vulnerability of vocation. A major work revisited (2015)
A Fortunate Man – a searching portrait of a country GP by essayist and
novelist John Berger – was first published in 1967. It projected a highly
personal view of medical practice: one undertowed by rich human complexity.
Nearly fifty years later, what does this anciently pioneering book offer us?
 Rick and Ajita: How may we
reconcile systems of healthcare with our subtle humanity? (2015)
Systems – our ordering of commonalities – have contributed greatly to our
treatment of structural disease. Elsewhere systems are much more problematic.
Rick and Ajita show us how and why.
 Evidence from Professional
Appraisals? We learn more about the governors than the governed (2015)
Professional Appraisals have become often absurdly complex, cumbersome and
remote, and then blindly authoritarian. Now they obscure and destroy more than
they can assure. What, then, do Appraisals tell us?
 Off-piste: only fresh tracks
lead to fraternalism in healthcare (2016)
Care Pathways – executively designed systems for all – can easily displace the
nourishment of our healthcare from fraternalism. What is that? Two intimate
Balint to Square-bashing. Fifty years’ experience of General Practice (2016)
Our healthcare’s increasing employment of complex technology is often
accompanied by a disinheritance of our human complexity. This inverse
relationship is undesigned but ever-more important. A personal history of the
Overdiagnosis? Yes, but what kind? Part 1: Geography (2016)
‘Preventing overdiagnosis’ should be an undeniable call. Yet even to agree a
definition will prove impossible. To understand why it requires us to look far
beyond the workaday tenets of our professional practice: the hinterland is
vast. This is the first of two parts.
Overdiagnosis? We need fewer systems and more philosophy Part 2: Geology (2016)
Contemporary medical practice now harvests two new and increasing tranches of
diagnosis: first, subjective experiences of discordance, disturbance or
distress; then symptomless but risk-linked biometric anomalies. These have led
to a massive medicalisation of areas of life often better otherwise understood.
Holism. We need literature of wit and grit more than piety and idealisation (2016)
‘Holism’ can easily become a politically correct, liberal healthcare catechism.
A recently published book of sterling values, The Snake in the Clinic,
illustrates the problem. Here is a review.
 Our ailing profession. We
need more than resilience and replenishment (2016)
The malaise among NHS healthcarers is akin to the patient dying from an
internal haemorrhage: oral replenishments, or even transfusions, may be very
inadequate. A recent day conference parried this perspective.
Art’s courageous experiments also be accessible? A review of a brief work of
brilliant obscurity (2016)
Sometimes art and philosophy tantalise us with ideas or experiences we can
never quite ‘get’. Sometimes, we may suspect, this is the author’s intent. Can
this, nevertheless, enrich us?
 How and Why Do We Retire?
Ill omens for younger doctors (2016)
The nature of our departures from our work often tells us much about what kind
of problems are being left behind. The individual may escape, but what about
the wider community?
 Introductory note to Death
by Documentation (2016)
 Death by Documentation: The
penalty for corporate non-compliance (2016)
Our organisational efforts to assure fail-safety, uniformity and probity can
easily – in excess – turn destructive beyond anyone’s wish or anticipation.
This tale tells how such ‘mission creep’ happens and how it is sustained.
 General Practice is the Art
of the Possible: but we are turning it into a tyranny of the unworkable.
Reflections on our inspections regime (2016)
There used to be a tacit assumption that healthcare (and welfare generally) was
mostly imperfectible, but that practitioners would generally do their best. All
that has been replaced by something very different. This long letter – to an
NHS inspection manager – shows in detail how we lose our professional trust,
identity and integrity.
 CQC Inspection and closure
of my NHS General Practice. Farewell from a long career
Letter to Chief Medical Inspector of Care Quality Commission, November 2016
 The Proof of the Pudding is
in the Eating: Actual and virtual realities: how our inspection culture
What’s really going on? How do we know? Who do we listen to: the participants
or officially designated inspectors? This response to a contended official
report – that rapidly closed down a small and very popular GP surgery –
portrays our difficulties.
 Is expedience the death of
our professional spirit? What our colleagueial utterances are telling us (2016)
Short-term adaptations to survive may – longer term – have the reverse effect. How
can this be? This short dispatch, from an ailing frontline of our NHS,
Big to Talk About. Organisational momentum: its paralytic wake (2016)
Corporatism often enlarges and entrenches itself by increasing demands for
compliance. Eventually though, unchecked, this will sicken any organisation.
Such is now evidently ailing our NHS. A brief glimpse from a small conference
provides a sample.
 I, Daniel Blake.
Industrialised humanity: why and how should we care for one another? Fraternal
wisdom from a film maker (2017)
How do we best assess the complex needs of others? Are these best served by
always increasing systems – now particularly computerisation and
proceduralisation – to determine our human contact? A recent film I, Daniel
Blake, cautions with courageous wisdom.
 When is Compliance Necessary
for Public Safety? The policing of Welfare: a personal story (2017)
Imposing managerial order onto some aspects of our natural human complexity is
far more easy and attractive to design than to sustain. Our misplaced and
excessive efforts can lose us far more than we gain. Here is one salutary story
and a broader analysis of social control.
 Holism is less about
eliminating root causes than tending our many branches. Reflections on
causation in healthcare (2017)
Attributing causes to human behaviour and predicaments may seem often essential
and sometimes easy: it is frequently tricky. With the pursuit of ‘root causes’
this is especially so – the greater our efforts, the more we are likely to
miss. An intimately observed example explains.
 Abolishing the NHS Internal
Market. Too big to talk about? (2017)
Our healthcare culture is now largely controlled by notions of commerce,
ubiquitous surveillance and micromanagement. The inevitable depersonalisation
is increasingly disliked by both healthcarers and patients. Nevertheless we
seem unable to reverse these effects. What is happening? How do we respond?
 When is Change Progress? Are
we throwing the baby out with the bath water? (2017)
Risk management and quality assurance must always be good, surely? Not
necessarily. More of something good is not always better. Sometimes we can add
more problems than we take away. A complex public event and two private
 David Zigmond: Biography for
Centre for Welfare Reform (2017)
 Should All Doctors be Resuscitators? Unfactored
costs of prescribed risk management Rhetoric
is easier than reality (2017)
Being prepared for unlikely risk or adversity may
sound like good counsel. But only so far: beyond that other things are damaged.
This speculative analysis is of a recent safeguarding inspection. It
demonstrates how apparently sensible procedures may, when extended, distort and
implicate far more than we usually imagine or intend. What happens? How do we
 The Cost of Everything and
the Value of Nothing (2017)
recent book NHS For Sale provides a trenchant analysis of how
the market brings waste, expensive complexity and inevitable corruption to
healthcare. But the damage is even more extensive: this review and reflection
 A Healthy Heart for the NHS? What is the
price of sacrificing personal relationships for public money? (2017)
A recent article, Back in the emergency
room, conveys clearly the twenty-five years of economic waste and
organisational inefficiency brought by the serial reforms to our NHS.
The author, though, does not address the human
damage and cost. Here is a corrective.
WRONG, WRONG … OUT! How can we contain one-size-fits-all policies? Three
struggling letters (2017)
Our welfare services are
increasingly controlled by RMIC (remote management, inspection and compliance)
regimes. Evidence of long-term benefits of RMIC are patchy and contentious;
evidence of damage or harm is much more substantial, and by many indices.
These problems, and the difficulty engaging authorities, are illustrated by
three letters between a coercively ‘decommissioned’ GP and a governing
authority (the Care Quality Commission).
 Hi Tech With Many Human
Hearts. Vitalising humanity from a film maker (2017)
A recent film Heal the Living (directed
by Katell Quillévérré, 2016) weaves a rich tapestry. Life’s vicissitudes, human
paradox and interconnectedness – all are here: holism at its most raw and
Spoiler alert: This
article describes much of the content of the film.
Vu. Twenty-first century healthcare reforms and post-war urban renewal (2017)
Two large reforming
movements in recent history have lost their human sense as they have gained
momentum. What did they overlook? What can we learn?
 Boadicea and The Machine. The price of survival as a
frontline medical practitioner (2017)
NHS doctors describe increasing stress,
pressure, demoralisation and alienation. What is this like to work in? Why is
this happening? A recent book, Your Life In My Hands: A Junior Doctor’s
Story, offers vivid description and challenging analysis.
or Procedures? Personalised treatment can be very different to personal care.
Recent advances in genetic mapping herald some
dramatically positive developments in hi tech healthcare. Yet this is
paralleled by unprecedented ailing demoralisation and alienation within the
service that will deliver these. How do we explain this discrepancy? What can
we expect? (13 pp)
So Sapiens After All. Lessons
for Welfare from a history teacher (2017)
The trials and tribulations of our Welfare system
have deeper and more complex roots than many can imagine. A recent and
remarkable book Sapiens: A Brief History of Humankind can greatly help deepen
and broaden our understanding.
Also published in the Journal of holistic healthcare, Volume 15, Issue 3, Autumn 2018, pp 63-64
Small Altercation: a Massive Residuum How
do large systems deal with outliers? (2017))
Speaking truth to power may be straightforward
in intent but rarely in course. This essayed letter to a health service
safeguarding board (NHS Care Quality Commission) illustrates typical
difficulties – personal, practical, philosophical and ethical. The questions
raised are crucial throughout our tribulated Welfare services.
happened to professional judgement and responsibility? (2017)
The erosion of a gratifying sense of
professionalism is now – belatedly – often cited as a major factor in the
collapsing morale of NHS doctors. How has this happened?
are we so resistant to holism? (2017)
Our technologies – so irresistibly convenient –
often enter our lives with costs that are more subtle: our more natural senses
of personal context, meaning and relationship. Why does this happen? What can
we do about it?
we fast-track primary care, what do we lose? (2017)
Speedier access, diagnosis, treatment and
despatch may seem like undeniable progress for our healthcare. Yet such
benefits may come with a large, though less obvious, sacrifice.
must always be better than cure, surely? The
potential perfidy of our expanding pre-emptive regulation (2017)
To effectively forestall trouble we often need
prescience, strength and boldness. Yet greater wisdom and probity sometimes
comes, instead, from nuance, discrimination and restraint. A current example
from healthcare and an elderly yet prophetic science fiction classic show us
how and why.
 Collectivising the Personal.
Seminal lessons from Bolshevism (2017)
There is a time-honoured principle and skill
involved in all medical practice: we must be vigilant to those times when our
interventions are making people ill, or iller. Ignoring this in public policy
can cause exponential damage. Unlikely co-examples? The USSR ninety years ago
and our contemporary NHS governance.
 Pornography in High Places. Reflections on
sex, calumny and human nature (2017)
Sometimes public accusations tell us, implicitly,
more about the numerous accusers than the solitary accused. What does that
mean? Here is one recent example, explored.
is deviation perversion? How do we assess real harm? Legality is often easier
to define than wisdom (2018)
The unexpected often alerts us to the
potentially malign. Defensive responses follow, often then blinding us to other
possibilities. Here is a surgeon who stepped out of line. How did we respond?
What did it mean?
 The Price
We Pay for ‘Certainty’. An unseemly tale (2018)
Living in a world of
ever-greater knowledge can bring us expectations that burden more than benefit
us. There is always a price for dividends.
Are Not Alone.
The healing shadow of the other (2018)
Apart from what we may do in
healthcare, why and how else are we important for one another? Accounts from a
recent illness and a colleagueial exchange explore.
 Shame: healthcare’s
unmeasurable undertows (2018)
Medical and mental healthcare have become
increasingly transmitted by notions and language of the explicit, the
designatory and the measurable. What happens to the rest of our humanity? Three
vignettes from different decades illustrate.
nostalgia becomes prophecy: an omened vignette (2018)
Sometimes ‘minor’ historic observations tell us
of very major changes we have undergone but not yet apprehended. Here is one.
Humanity. How may we best care for one another?
A dialogue between the Centre for Welfare Reform and Dr David Zigmond (2018)
Massive advances in our technology –
particularly IT – have made possible new forms of ‘evidence-based’ corporate
management and industrialisation. These have frequently been linked to
But such ‘advances’ are paralleled by growing distress and demoralisation
throughout our welfare services. Why? What can we do about it?
 Life After Death? A posthumous dispute (2018)
end of contractual employment usually terminates our legal
responsibility. But what about our moral responsibility
toward unattended compromises we know we are leaving? How well can
ghosts speak for, and to, the living?
Here is a virtual dialogue with healthcare’s governing authorities.
 Bad humanity is bad economics: the perils of industrialised healthcare (2019)
In 2014 the venerated King’s Fund published Reforming the NHS from within. Beyond hierarchy, inspection and markets.
This was a diligent but bold study shows how recent reforms have helped
neither the economics nor the efficiency of the system. Subsequent
events have shown, increasingly, that report’s accuracy and thus enduring relevance.
But the King’s Fund did not venture to define or explain the
psychological or social damage caused by the flawed reforms. This
omission is important: the King’s Fund is powerfully influential, and
so – often – are their reports.
This paper addresses those omissions and then offers some remedial suggestions.
 ‘Two stars and a wish’: can the best of ourselves
really be regulated? (2018)
Regulations are sometimes mandatory for public safety, probity and
decency. But what is the role of the regulator in our subtler activities of
Welfare? Eve’s predicament is now common: it should caution us.
 How may disciplining authorities best be dialogic? Should
governance have limits in Welfare? (2018)
Is the nature and quality of our healthcare a
primary social and political responsibility? If so, its assurance – by
governmental regulation, management and inspection – must always be good,
Not so: more of something ‘good’ is not always better – it is often worse. This
paradox is often refractory to dialogue. An essayed letter, to a senior officer
of a healthcare executive body (the Care Quality Commission – CQC), samples
this process and what can happen.
 Rehumanising General Practice? A cautionary tale (2018)
and how are personal and family doctoring becoming extinct? An account
of a clash with governing authorities – here published in e-Organisations & People – illustrates.
 Our ailing NHS: the follies beyond our financial struggles (2019)
our successive healthcare reforms provided, as promised, better
efficiency and value for money? Or have they, rather more, created both
psychological and social damage to healthcarers and thus the care they
 This is Going to Hurt ... so how do we bear the pain? (2019)
Why and how do we conceal or displace our most painful experiences with public displays of humour? A recent bestseller This is Going to Hurt leads us, with doomed wit, to a darkness beneath.
 Admissions: a neurosurgeon’s life of devotion, struggle and resignation (2019)
How much can
autobiographical reflections help us face our larger shared problems of
humanity? This essayed review exploresAdmissions, a very personal and
long-term view of healthcare.
 The disintegration of General Practice is mostly due to its serial reforms (2019)
is it so difficult to get continuity of care, or even an appointment,
with your GP? And why is the GP workforce now so unhappy and depleted?
Here are some explanations beyond those of increasing demands and how
we finance them.
 Unravelling General Practice: the tragic legacy of our serial reforms (2019)
and how are we caring so ineptly for the services that must care for
others? The current plight of General Practice has much to teach us.
M. Transcripted interviews
1 A day in the life
Interview with Pulse, October 2014 – Article 53
2. Only personally fulfilled
practitioners can deliver good personal healthcare
with Independent Age, May 2016 – Letter 49
may we best care for one another?
John Burton from the Centre for Welfare Reform, February 2018 –
4. Life After Death? A posthumous dispute
2018 - Article 108
Section Contents Copyright ©; Dr David Zigmond 1976,
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Version: 16th July 2019