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J R Soc Med. 2002 March; 95(3): 165.
PMCID: PMC1279501

Edge of chaos

Mr Papadopoulos and his colleagues1 (December 2001 JRSM), using the mathematics of power relationships, conclude that the NHS is a complex adaptive system operating on the edge of chaos. That the NHS is a complex adaptive system has also been proposed from a conceptual point of view2,3.

Having discussed convincingly how the NHS, in common with other complex adaptive systems, is resistant to change, they then speculate that the way to shorten waiting lists is to double or quadruple funding. Whilst clearly the NHS is under-resourced, such a policy is unlikely to be embraced by the government or taken seriously by health service planners.

Cilliers4 has suggested that complex adaptive systems can be highly creative, their inherent self-organizing capacity allowing them to adjust well to new opportunities. Even multinational corporations can increase their competitiveness through allowing employees to work creatively in small groups, within strategic guidelines but with little interference from management5. This principle has been suggested as relevant to the NHS6.

If the NHS were reorganized into smaller units, based on populations of 100 000 (as originally envisaged by the introduction of primary care groups and trusts), and these were freed from overburdening central control, the inherent creativity of these smaller units would probably lead to enhanced efficiency7.

Whilst there are hopeful reports that the government is considering such proposals8, there must be doubt whether it will take the political risk of relinquishing central control.


1. Papadopoulos MC, Hadjitheodosiou M, Chrysostomou C, Hardwidge C, Bell BA. Is the National Health Service at the edge of chaos? J R Soc Med 2001;94: 613-16 [PMC free article] [PubMed]
2. Greenhalgh T. Change and complexity—the rich picture. Br J Gen Pract 2000;50: 514-15
3. Dick P. The NHS as an ecosystem. Br J Gen Pract 2001;51: 248-9
4. Cilliers P. Complexity and Postmodernism: Understanding Complex Systems. London: Routledge, 1998
5. Senge P. The Fifth Discipline: The Art and Practice of the Learning Organisation. London: Random House, 1990
6. Davies H, Nutley S. Developing learning organisations in the New NHS. BMJ 2000;320: 998-1001 [PMC free article] [PubMed]
7. Bojke C, Gravelle H, Wilkin D. Is bigger better for primary care groups and trusts? BMJ 2001;322: 599-602 [PMC free article] [PubMed]
8. Ministers will order NHS to shift power to local hospitals. Sunday Times December 2001: 1-2

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press