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PCT clusters seem to be concentrating power at a level above the statutory board, ever more remote from patients.

It seems strange to be setting up such a power base for the 'old guard' yet tasking it to create a new order within which the test of cluster's success will be their irrelevance, and the loss of jobs of their leaders.

As for the 'secondary legislation' it is a good idea intellectually, but politically wont wash. Nobody (including many within the coalition) will trust that primary legislation problems will be voted in based on a commitment to fix them in secondary legislation later.

Secondary care clinicians involvement? We could always try Networks and Clinical advisory groups, with commissioners required to consider their, and the public's views in making decisions. That way we'd get influence without a conflict of interest (turkey's voting for Christmas) on the commissioning body boards.

Hang on, wait - that's the CURRENT system.