Published: 10/01/2001, Volume 112, No. 5787 Page 19
If NHS managers in England are hoping for more autonomy, their counterparts in Scotland start the new year fearing another move towards greater centralisation. Despite official denials, rumours are rife there that the Scottish NHS's remaining 28 trusts - already cut from 46 five years ago, and brought under unified health board control last year - may be candidates for outright abolition.
Scottish health minister Malcolm Chisholm, who has launched a review of management and decisionmaking, should heed the reaction in England to the Shifting the Balance reorganisation: when the priority is improving the service sufficiently for patients to perceive the difference - as it is in every part of the UK - the very last step should be diverting management time and resources to yet another restructure. The NHS should simply work with and around the shortcomings of the current system until it has earned a little time and space for the luxury of another reorganisation. It is fanciful to suppose that more reform would be a panacea or that it would not in turn introduce as many problems as it was intended to solve.