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A Dutchman in London: reflections of a hospital chief executive from the Netherlands in the NHS
  1. Marcel Levi1,2
  1. 1Department of Medicine, University College London Hospitals NHS Foundation Trust, London, UK
  2. 2Department of Vascular Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
  1. Correspondence to Dr Marcel Levi, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK; marcel.levi{at}


Background The NHS is a fascinating health care system and is enjoying a lot of support from all layers of British society. However, it is clear that the system has excellent features but also areas that can be improved.

Story of self A number of years as a chief executive in one of London’s largest hospital has brought me a wealth of impressions, experiences, and understanding about working in the NHS. Contrasting those to my previous experience as chief executive in Amsterdam (The Netherlands) provides an interesting insight.

Observations Very strong features of the NHS are the high level of health care professionals, the focus on quality and safety, and involvement of patients and the public. However, the NHS can significantly improve by addressing the lack of clinical professionals in the lead, curtailing ever increasing bureaucracy, and reducing its peculiar preference for outsourcing even the most crucial activities to private parties. The frequent inability to swiftly and successfully complete goal-directed negotiations as well as the large but from a clinical point of view irrelevant private sector are areas of sustained bewilderment. Lastly, the drive for innovation and transformation as well as the level of biomedical research in the NHS and supported by the British universities is fascinating and outstanding.

  • management
  • patient involvement
  • performance management
  • professionalism

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  • Contributors ML conceived the idea, and wrote and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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