Simon Stevens’ recent pronouncements will revive the long-term debate in the NHS about the balance between national and local approaches to running the English health system. In an interview with the Daily Telegraph, he called for `more local hospitals’1,2. He elaborated this point in his NHS Confederation conference speech when he argued that:

Professor Mark Exworthy

“Just as there’s been a push for centralisation there’s been a pull for more local and community-orientated service”3.

Since its inception, at the heart of the NHS lies a tension between the `national’ and the `local’. The very term `NHS’ seems to infer that it is uniform in scope and delivery. To some extent, this is correct. The NHS remains a single-payer system and funded from central taxation; no (major) political party is willing to rescind this, possibly because its `national’ dimension remains a potent symbol for politicians and the public. For much of the life of the NHS, it has pretended to be centralised in its planning (in terms of, say, staffing or buildings). Many of such vestiges remain. Although reforms by Andrew Lansley have removed some significant powers of the Secretary of State, this doesn’t mean that that ministers (as in previous administrations) have been averse to becoming embroiled in local NHS matters. Indeed, the phone call from the Minister remains a notorious form of direct, local intervention from the centre...."

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Staff profile for Mark Exworthy