comment: Reorganisation plans show that the centre is playing its part in reform

Published: 06/02/2003, Volume II3, No. 5841 Page 19

The news that the Department of Health is embarking on plans to streamline and refocus its operations (news, pages 4-5) is welcome. However, it is not the first indication that the centre is prepared to make the changes first heralded in Shifting the Balance.

The decision to devolve control of modernisation funds to strategic health authorities (news, pages 4-5, 10 October 2002; news, page 7, 12 December 2002) was a clear signpost for the direction of travel.

In addition, we have a group chaired by junior health minister Lord Hunt - a followup to July's Cabinet Office report on reducing the bureaucratic burden placed on the service. HSJ understands that even the prime minister is taking an interest in cutting DoH red tape and has asked health ministers to keep him informed of progress.

Now NHS chief executive Nigel Crisp - who is, of course, also DoH permanent secretary - has made the clearest statement yet that the number of targets the service will be judged on has been significantly reduced (news, page 8).

The next step is probably the most difficult. There is an iron rule of government which states that every layer of central bureaucracy creates the need for more civil servants who, in turn, generate greater demands for information from the service they administer. The only really effective, sustainable way to control central bureaucracy is to limit the number of civil servants.

But this is not simply just about fewer civil servants - it is about fewer civil servants doing the right jobs. And the expected focus on implementation is also welcome.

A slimmed down, better focused DoH may not necessarily be a more effective one - but it has got a better chance of achieving its goals. It is almost certain to enjoy a more productive relationship with the NHS grass roots.