'The NHS too often guards its plans for too long and too fiercely'

A key element in HSJ's charter for high-quality management, part of our Managers Make the Difference campaign, is that they play a key role 'in making the case for difficult decisions to [external] stakeholders'. And we know that the support for tough choices pledged by acting NHS chief executive Sir Ian Carruthers will count for little if important local influencers are excluded from decisions on reconfiguring health services.

However, our snapshot survey of overview and scrutiny committee chairs shows that even when they are broadly supportive of local NHS organisations, they remain ambivalent at best about the quality of consultation. While more than two-thirds said they had a good relationship, almost three-quarters believed that the NHS was not good at involving local people in decisions.

Some of the comments that accompanied the survey show a perception that the NHS too often guards its plans for too long and too fiercely, in the hope that local politicians simply won't notice. This is holding a lid on a boiling kettle, a practice that can scar local relationships long after the immediate concerns have been resolved.

However, as we reveal next week there are some real success stories about how the NHS has brought local councillors and MPs into the fold and worked hard to understand their priorities.

The new strategic health authorities - not just those with chairs from a local government background - will be keen that others learn from these lessons.