Just as the government’s fingers are finally being prised off the throat of the NHS in England, Welsh health minister Edwina Hart has put her own service in a stranglehold.

In England’s terms she is, in effect, the secretary of state and NHS chief executive rolled into one. Hardly surprising, then, that her decision to chair a national advisory board that will plan, fund and hold services accountable has left her open to charges of becoming the country’s health commissar.

There are good reasons for streamlining the Welsh health system, where the internal market has never taken hold, but the new structure has more than a whiff of Stalinism about it. Dissent is hard to find - even the British Medical Association has acquiesced.

Personality politics

The new system also suffers from being moulded too closely to the personality of the incumbent. Over the years British politics has thrown up numerous examples of government departments being shaped to suit the obsessions and egos of powerful ministers, but too often this creates the conditions for longer-term instability. If Ms Hart’s successor is less comfortable with managing the minutiae, another restructuring may well be required.

There is a place for politics in healthcare - life and death are political issues - but the appropriate role is not day to day control. Managers, clinicians and patients are where the power should reside, not in the hands of someone distant from the action who is under the sway of transient political pressures.