This is the argument I don't really understand. Whilst I believe the majority of MP's are conscientious professionals there is undoubtedly a minority who are lazy, incompetent, dishonest, complacent or any combination of the above. They win re-election because they are fortunate enough to sit in constituencies where just enough core party support can be relied on to keep them there. AV just makes it easier to overcome party loyalty and hold these people to account. It is not, of course, a silver bullet, it won't work in every situation, but to my mind some is better than none. Marmora Man, I am puzzled therefore, as to why you should call on one thread, for easier ways of cutting the dead wood out of the NHS and yet support a system which helps protect it in the House of Commons.