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Our public health system: an accident waiting to happen?

Our public health system, addicted to increasing centralisation and regulation, is pushing our everyday work environment beyond the point of sustainability — it has become too complex. Like an ecosystem grown too complex to resist sudden environmental change, public health organisations have become “brittle”, unable to respond to changing conditions. Another bureaucratic restructuring, such as recommended by the Garling report, can only be self‐defeating. It is time for us to design systems small enough, and therefore resilient enough, to meet tomorrow's challenges.