Assembly is clean slate for relations between managers and ministers

The 'most thorough report ever produced on the financial management of the NHS in Wales' - the description is Welsh first secretary Alun Michael's - throws inadvertent light on that perennially intriguing relationship between ministers and managers.

Produced by the Welsh Assembly's policy unit at Mr Michael's command, the 'stocktake' report was prompted by the NHS in Wales' extravagant financial problems. Despite funding 13 per cent per head higher than in England, the Welsh NHS ended the last financial year with a lurid£72m cumulative deficit.

The stocktake is careful not to name, shame or blame any individuals, although Bro Taf and Dyfed Powys health authorities, and their associated trusts, between them accounted for£49m of the deficit. Instead, it emphasises the impact of external events, while noting that 'most of the factors discussed' existed in other HA areas in Wales.

Chief among these are the internal market, 'short-termism' and competing priorities. Ten years ago, managers were conspicuous as the only professional group in the NHS which supported the introduction of the internal market; few challenged the wisdom of their then political masters.

Today, the internal market is a politically safe Aunt Sally on which to heap all manner of ills, some of which is even justifiable.

Short-termism amounts to that irresistible temptation facing managers to let a difficult financial position deteriorate until politicians are left with no choice but to hose down the hotspot with cash.

And why not play the system? Ministers do - by, for example, piling new imperatives on managers' shoulders when it is politically expedient.

With the advent of the Assembly, the NHS in Wales has the prospect of a new start, with fresh ground rules governing relations between managers and ministers. Will it lead to better mutual understanding or more interference and resentment? Lessons from the stocktake should be studied minutely.