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As long as Sir David sits atop the NHS you will have one model - Stalin style top down control. What makes it worse is that there is no plan to operationalize beyond maintaining the "Sir David Control Model" so anyone who was hoping for a different results is reminded of the quote attributed to Einstein about "insanity being defined as doing the same thing over and over, and expecting a different result." And to see Sir David publicly take postions diametrically opposed to Lansley and the legislation's bespoke intent - and not get called to task for it - is an active danger to achieving the outcomes that have been called for. Never underestimate a bureaucrat's ability to put their own motives ahead of their constituents...