'Mr Nicholson wants to look at how funding can be released so trusts have to rely less on a system which is in effect designed to produce a deficit.'

New NHS chief executive David Nicholson has begun his job with a clear desire to grease the wheels of Department of Health policy-making and take the brakes off local action and innovation.

He says there is appetite within the DoH that it can move more quickly to provide answers that managers need - there is no need for months of deliberation by 'very clever people'.

He also wants to look at how billions of pounds of funding can be released from the centre over the next few years so trusts have to rely less on uncertain assumptions when planning - a system which currently, Mr Nicholson says, is in effect designed to produce a deficit.

Culture change

Mr Nicholson wants to break what he sees as culture of dependency between the service and the centre - he tells a probably apocryphal story about the Department of Health being asked by a trust to provide a tariff for e-mail based rheumotology follow-ups. His brisk view is that if you are holding your breath for that kind of central mandate, you will expire. In other words, just do it.

But there is another side to that bargain. If trusts do get on with it, they need to be rewarded and lauded not just by Mr Nicholson but his many colleagues in the DoH, many of whom draw a pay cheque for making decisions on behalf of local trusts and who may quite want to continue doing so. And trusts need to know that the intermediate tier is equally dedicated to local freedom to manoeuvre.

All that said, Mr Nicholson's fundamental personal principle seems to be 'keep the promises you make'. So trust managers should be encouraged to take him at his word and grasp the opportunity for local decision making.