comment: More restructuring brings an opportunity to learn much-needed lessons

Published: 31/10/2002, Volume II2, No. 5829 Page 17

The blocks of Lego are strewn across the floor of the Department of Health once more. As the service in Wales prepares to replace five health authorities with 22 local health boards in just five months, the man in charge of the programme alerts us to 'major risks' that the timetable cannot be met (news, pages 4-5).

Why? Senior managers and chairs express fears that an overdose of political scrutiny has meant that salaries have been set at levels to appease the public rather than attract the best candidates. They are also concerned at the lack of 'buffer' between the Welsh Assembly and the service, leaving officials and managers teetering uncomfortably between political, strategic and operational roles.

This week's HSJ tells us that there are lessons Welsh service planners can learn six months down the line from England's rearrangement of its structural furniture. One is that new structures can no better deal with historic problems than their predecessor bodies. Witness Surrey and Sussex strategic health authority's ever-increasing deficit (news, pages 8-9) and the warning signs emerging from Southampton University Hospitals trust (news page 7).

As the Lego blocks appear again at the DoH, this time the focus is not structures but bricks and mortar. A draft of the long-awaited configuration framework examines examples of different networks of care to balance the need for local services with clinical and staffing pressures towards centralisation (news, pages 4-5; news focus, pages 10-13). The document is a tribute to the so-called 'Kidderminster effect' and calls for a sea-change in building 'services designed with local populations, not for them'.

A pipedream? The pioneering partnership between campaigners and the NHS in west Cornwall offers a tantalising glimpse of what true consultation could mean.