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Interesting piece. As often the case with Respublica matterial - it combines thought-provoking and original thought with a bit of superficial tosh. Let's get some of the tosh out of the way first:
- the idea that we've all been pushed into defending the status quo. There's enough evidence of change andf good practice out there to show that isn't true. I don't think Blond had really looked hard enough. Sorry Phillip.Plus it wasm't just that we distrusted the changes or the motivation. We mainly just thought they were rubbish; no evidence base, no coherence, no structured thought process or engagement and reliance on a market model that didn't work for anything outside elective ops in big cities
- there's been a will for internal change for a long time, but politicians have played a big role in hindering change
- don't rubbish 'an association of exeperts' on matters of quality, safety etc. It's naive and silly. Save it for the Daily Mail
- Big Socity policy or legislation isn't mainstreaming. Don't pretend it is - bluff and bluster makes a proper debate harder on what localisation is and what it can achieve

OK. Enough. Let's look at the positives:
- I think Blond is spot-on on highlighting the need for a redining of the state/individual roles. In areas like chronic conditions the more personalisation we can achieve, the better. But don't lets pretend that micro-commissioning is the model for rvrything. The best private sector rnterprises recognise the value of strategic planning, and the NHS must too. What we need are models that use both local and strategic, according to need and purpose.
- which leads onto mutuality. the US model Blond cites is really interesting. . I'm not wholly convinced of the notion of a holistic provider and there are real and practical funding flow issues that would need to be picked apart. However, the principle of different interests working more effectively together can't be faulted. It's what good MDTs, CMHTs etc do alraedy on a more limited scale.
- Blond is absolutely right to stress the importance of chronic conditions and to highlight this as a key area for change. It's where Lansely and the Health Act failed so spectacularly. I don't agree with histheory of the shift away from acute (there will always be demand for acute services, and active chronic case management won't by any means sotp emergency admissions. Sorry again Phillip). But he's right to talk about thie potemtial for shift and the role of consumers in driving that

But the key question remains - how can these shifts be achieved ? It's not solely about professional resistance to change, and I think the Health Bill achieved almost nothing in this key area. Pragmatically, there are two things we need to answer:
- what needs to be done strategically and what can and should be done locally/personally ?
- follow the money ! if we want to run different models, we need to work out how the funding will flow (bear in mind there's issues of sustainability as well as flexibility)
- how can we get mutuality working and get providers to work with it (both private and pub,lic need to do work on this)