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So 'competition' and 'plurality' were never more than a temporary stick with which to beat the status quo? Now that waiting lists are down the NHS can go back to the cosy monopoly old boys network it always was. PCT managers migrate to NHS Trusts and vice versa and no real change. And in any case the doctors can kick managers' (soon to be 'administrators') asses like they always used to. His tired litany of yesteryear promises is laughable - 'Top-down efforts must give way to a bottom-up approach - principally led by empowered patients and engaged staff' - anyone old enough to remember 'Putting Patients First (I don't know if Andy is)? How about 'health and social service working closely together' which was in the HSJ 30? 40? years ago and we still don't see it The sop to the independent and voluntary sector for the time and money they have put in the vain belief that a 'level playing field' will eventually emerge? Here it is - 'If we are serious about quality and we challenge underperforming services in the ways I suggest, then it is possible that their role will increase rather than diminish'. Hmm - would you invest in an independent sector unit on the basis of that? Well done Andy and welcome everyone to the seventies - shift Ministries Andy and we'll soon have a three day week...