Prime minister Tony Blair has dropped a subtle hint that his government may at last appreciate that it needs to allow NHS managers a little more freedom. Speaking at St Thomas' Hospital, London, as HSJ went to press, he said that trusts which embraced change and modernisation 'will increasingly find that we leave them to get on and provide people with a good service'. And he added: 'We will not only get off your back. We will reward your effort.'
As ever, the stick was never far from the carrot. Those who failed to bring about change would get 'support and intervention', even to the point 'where necessary', of 'someone else running the show'.
But for the first time, successful bids for earmarked cash may come with an understanding - tacit or explicit? - that the managers involved will have greater scope to use their initiative. Not before time. Criticisms that they are being stifled by central control have now reached a crescendo.
Mr Blair's statement, the Department of Health's new strategy unit and its proposed modernisation board - which would bring senior frontline staff to the heart of policy-making - may be encouraging signs that at last the message is beginning to get through.
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