Elements of decentralisation in plans to reform NHS may prevail

doi:10.1136/bmj.317.7160.753

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Chris Ham, Director

Health Services Management Centre, School of Public Policy, Birmingham B15 2RT

EDITOR—Klein and Maynard correctly diagnose centralising tendencies in the government's approach to the management of the NHS.1 What they fail to acknowledge is that there are also decentralising tendencies, and it is unclear which of the two approaches will prevail.

Decentralisation is most evident …