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It is true that Lansley's structural reforms have been largely negated by NHS England and LATs. It was also entirely necessary. The sad thing is billions have been wasted throwing the pieces up in the air and then putting them back together again.

Service change is essential and has to be led from somewhere if the NHS is to survive and improve. CCGs are not big enough and don't have the reach - reconfiguration is likely to cover larger areas than CCGs do - and if their solution is to walk away, they will go bust before long in a system that is not clinically or financially sustainable.