Adrian Crisp cogently advocates a regionally devolved NHS, with local ownership, policy and management.1 This in fact existed with the first major restructuring of the NHS in 1974, after two years’ careful preparation. Regional Health Authorities had a board comprising representatives of civil society, local government and professional bodies, which met in public. The Regional Health Authorities had considerable autonomy in service design and operation, with operational delivery being conducted by District Health Authorities. Financial resources were allocated according to assessed health need, together with legacy responsibilities. Simple but effective control was through an annual performance review with the Department of Health, as well as financial audit and professional regulation. The system worked well for a number of years, with considerable development in integration and equity being achieved, and addressing of longstanding problems including estate deficits and workforce planning. It fell victim in 1982 to the next of the subsequently recurrent waves of political wisdom which demanded that politicians knew best and should be able to issue directions, and restructure the way of business. Since then the NHS has been a political plaything, with huge waste of resources, morale and direction due to perpetual changes by those with no technical knowledge or experience.
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