Expertise as Infrastructure: What Medicine Reveals About the Country We Are Becoming

I care deeply about this country. Over more than three decades working within the UK’s healthcare infrastructure, I have observed both its strengths and its limitations. Recently, a visit to Dubai brought these reflections into sharper focus. There, deliberate investment in expertise and knowledge was treated not as optional, but as essential to national development.

Returning home, I could not help but ask: what does the way we now treat expertise in the UK say about the kind of country we are becoming?

Medicine as a Lens

Medicine is a highly knowledge-intensive, high-stakes profession. When expertise functions well, it is often invisible. When it is eroded, consequences eventually surface. Over the years, I have noticed a subtle but persistent shift: decisions about triage, clinical prioritisation, and escalation increasingly occur without consultation with the clinician  ultimately accountable for outcomes. These decisions are often well-intentioned-framed as efficiency, or service delivery-but they assume that expertise is interchangeable.

Clinical judgement is not optional. It is built over years of training, exposure, and responsibility. Flattening hierarchies and substituting protocols for experience may improve short-term throughput, but it does so at the cost of long-term safety, innovation and professional development.

The Signal to Future Generations

There is a deeper cultural consequence. When expertise is routinely diluted, future generations see mastery as unrewarded or unnecessary. Why invest years in acquiring complex knowledge if it is neither recognised nor meaningfully applied? They are more incentivised to set up TikTok accounts and gain fame rather than spend years gaining expertise through clinical training and practice! Over time, this all ultimately produces a workforce optimised for functioning rather than leading, innovating, or anticipating risk.

This is not just a professional concern. Innovation across sectors-science, technology, healthcare, and industry-depends on people who understand complexity, recognise when standard procedures are insufficient, and are empowered to challenge assumptions. Flattened hierarchies may improve efficiency today, but they discourage mastery tomorrow.

Expertise and Strategic Incentives

Part of this shift may be structural. In healthcare systems influenced by private operators, simplifying hierarchies and diluting specialist roles can optimise short-term profitability. Staff become interchangeable, administrative complexity is reduced, and costs are controlled.

While this may serve financial goals, the long-term consequences are profound. By devaluing expertise we risk stifling innovation, reducing distributed knowledge and concentrating influence in the hands of a few operators who control processes rather than understanding. Systems may function, and profits may be realised, but societal capacity to adapt, innovate and lead diminishes.

Lessons from Abroad

In Dubai, expertise is deliberately cultivated. Specialist training, mentorship, and international collaboration are viewed as critical to national progress, not optional overhead. Knowledge is embedded alongside local professionals, building capacity that is distributed, respected and future-facing.

This approach treats expertise as infrastructure-as essential to development, not as a cost to be minimised. It is a stark contrast to the subtle ‘dumbing down’ I see increasingly in UK systems.

The Human Cost

The erosion of expertise has tangible consequences. Anecdotally, I have witnessed countless colleagues-both senior and early-career doctors leave the UK. People I trained with from the 90s no longer practice in the UK. From my perspective, these are professionals in whom the nation has invested heavily, yet the system has failed to retain them.

This is not just a professional loss; it is a national loss. Years of training, experience, and skill development are exported rather than leveraged domestically. When a country fails to support expertise, it is not only failing its professionals-it is failing itself. Each departure represents missed innovation, diminished capacity, and a weakening of the very systems the country relies on to function and advance. The message to those remaining is equally clear: deep knowledge may not be valued, and mastery may not be rewarded.

The Larger Question

I often ask myself are my expectations “too high”. However upon further reflection, the real question is:

Can a country that systematically devalues expertise remain innovative, resilient. And competitive?

Efficiency without depth is fragile. Standardisation without understanding is brittle. Progress that erodes mastery is not progress at all. Healthcare is a warning bell, not  an exception. If we fail to protect and invest in expertise here, it is unlikely the country will succeed elsewhere.

A nation that wants to lead must make a deliberate choice: to value expertise not as elitism, but as a strategic asset. Without that choice, we may continue to function day-to-day but we risk quietly losing the capacity to advance.