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BMJ. 2007 October 20; 335(7624): 828.
PMCID: PMC2034728
Past Caring

A man who called hospitals to account

Wendy Moore, freelance writer and author, London

Sir Derek Wanless is not the first banker to call health services to account with his hard hitting criticism of productivity and efficiency. Predating the former NatWest chief executive by more than a century, the unsung pioneer of modern hospital management Sir Henry Burdett (1847-1920) started out as a humble clerk behind a desk at Midland Bank in Birmingham.

The son of a vicar who harboured ambitions to become a doctor, the young Burdett had to abandon his altruistic aims at 17 when his father's death put paid to his university plans. In the balance sheet of history, his loss was health care's gain. Burdett's brief spell with the world's local bank sowed a passion for figures which inspired him to modernise the world's local health services.

Appointed manager of the Queen's Hospital, Birmingham, four years later, Burdett embarked on a lifelong crusade to improve standards of accounting and management in hospitals worldwide. Although he spent only 12 years as a hospital manager—his second post was at the helm of the Dreadnought Hospital, Greenwich—before turning to business, Burdett launched a revolution in management practices which reverberates today.

Championing ideas ahead of their time, Burdett pioneered hospital league tables, clinical audit, standardised accounting, and general management. He firmly supported lay authority over doctors, introduced the first registration system for nurses, and was the main mover behind the foundation of the King's Fund, which would commission a study by his banking successor 110 years later.

Tirelessly collecting hospital statistics with the aid of a secretary, a primitive typewriter, and the Victorian postal system, Burdett published figures for everything from mortality rates to the cost of leeches in his annual tome, The Hospitals Year-Book. Scathing in his criticism of inefficiency, he pronounced St Thomas's “among the least successfully managed hospitals in London”—and Guy's was “in an even worse plight.”

His outspoken views did not endear him to the clinical professions. Florence Nightingale refused to be photographed with him, and his reforms at Addenbrooke's prompted one doctor to declare: “Everybody was contented until in an evil day they called into their counsel Sir Henry Burdett.”

But for all the professional snobbery against the erstwhile bank teller, Burdett was impeccably connected. He was knighted by Queen Victoria and counted the Prince of Wales (the future Edward VII) among his closest friends. His advice was sought throughout the British Empire and beyond. As a prototype management consultant, he offered his expertise to hospitals from Chicago to Russia, and his Christmas Day was never complete without a ward visit. Although he was fiercely opposed to state intervention—he described politicians as “the curse of the sick”—his reforms paved the way for the modern NHS.


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