the issue is as much about who controls and for whose benefit. Right now the NHS is run by medical staff for medical staff and patient comfort and convenience, let alone cost are way way down the list. Procedures require effective management for efficiency and, although in the medium term costs will be reduced, in the short term disruption costs may be very high with parallel practices to maintain continuity.

This requiress a centralised control of expensive expertise to manage.

Equally the choice of medicine may seem like a no-brainer, but cost effectiveness is best maintained centrally. there are treatments for cancer which are simply not cost effective, however attractive they may be. For instance there is a new cancer treatment which costs £50 K a month and prolongs life by about 6 - 9 months. If it was a cure, I would agree that it we pay the price. but it isn't, it simply lengthens the dying. Now, however much I can understand that a dying person might think that an extra day, let alone half a year is worth any price worth paying, across a population it simply cannot be justified.

those decisions at local level are political poison, careers can be ruined. but an national level they can be justified and enforced.

this policy is stupid, short-sighted, expensive and massively counter-productive. All in all, a typical poltician's intervention

keep to the Fen Causeway

So, what is it that they propose to "decentralise"?

By laying out pros and cons we risk inducing people to join the debate, and losing control of a process that only we fully understand. - Alan Greenspan