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Thank you for publishing this collection of views.
May I suggest that the next step is to publish outline proposals for
alternative structures and the rationale behind each.
The central thrust needs to be the effective delivery of service and
that requires explicit limits and coherent collaborative networks,
precludes complexity and obviates the involvment of commercial elements.
My own vision is of service control mechanisms composed (top to
bottom) of three interdependent co-equal elements: users,
clinicians/workforce and managers/politicians. A central broad policy
making unit (this is the Independent NHS authority, not the DoH) and
county-based implimentation units having wide discretion to take account
of local circumstances and with the requirement to co-ordinate with
adjacent areas for the equitable and geographically sensible provision of
The remit would be inclusive - primary, secondary and associated
services as a coherent whole.
No market. No pricing. Evidence based policy with monitored
implimentation of novelties in test areas etc etc.
We aspire to deliver a service, not to be corrupted by half-baked
notions of market forces.
I support the separation of NHS from immediate political interference.