In response to your article - BBC-style management could save NHS from 'political ice', I can't think of a much worse model to aim for than the BBC. It is effectively funded as a tax on all TV owners, irrespective of whether they actually use the service or not. And growing issues of choice in broadcasting are making this a very hard principle to follow. Users cannot opt out of the TV license fee, which would be entirely reasonable if they did not consume the service.

In response to your article 'BBC-style management could save NHS from 'political ice'', I can't think of a much worse model to aim for than the BBC. It is effectively funded as a tax on all TV owners, irrespective of whether they actually use the service or not. And growing issues of choice in broadcasting are making this a very hard principle to follow. Users cannot opt out of the TV license fee, which would be entirely reasonable if they did not consume the service.

The BBC is also being shackled by a below inflation rate increase in.license fees and is expected to find 'productivity improvements', just as the.NHS is. This will lead to a curtailment of services and a reduction in quality. The issue of a 'commissioner' of programmes versus producing their own is one that continues to bedevil the BBC. There are quite strong arguments to suggest that it should move more towards commissioning. Looking ahead, the whole question of the 'public broadcasting service'.element of the BBC package, as compared with a perceived need to provide something for everybody (since they all pay the license fee), also remains to be resolved.

The BBC is also.in competition with the private sector. Its market share has fallen sharply over the last few years as the number of independent channels has multiplied. Whether the BBC should continue to be maintained at its current size and scale into the future is debatable. All of which is rather different from the NHS.

Structural changes in the health system

In the NHS, perhaps the following is useful. First, it might help to stop talking about the NHS.- there are commissioners, primary care trusts, health care deliverers, trusts, foundation trusts and other units. One structural reform would be to make clear that the commissioner's responsibility is to provide funding to ensure people are.adequately treated at an affordable cost. Once the costs have been set centrally - determined by the share of health expenditure as a proportion of gross domestic product.- commissioners should be allowed to try to maximise their health benefits while minimising costs. This includes a much greater willingness to shop around for treatments and to reduce the block grant element to the service providers. Commissioners should have no involvement in service delivery.

Service providers will be freed up to choose, within limits, what to offer. This will involve a degree of competition among suppliers, and also the private sector. Providers will increasingly regard patients as a source of revenue, rather than a source of cost, as is the case at the moment. Left to its own devices, we might be pleasantly surprised at what the health system can deliver. And where the Department of Health, the strategic health authorities and other elements sit might end up being a relatively minor matter.

By all means increase the distance between the politicians and the health care system. But try not to follow the BBC as a model - it won't work.

Dr Andrew P Black is managing director of.Building Value Associates.