It is clear from discussions at the Labour Party conference that ministers are not willing to commit in any meaningful way to accountability to patients and the public. They feel that patient and public involvement will result in a postcode lottery followed by assassination by the press.

We all agree that services need to be built around the patient. In the same way, services must also be tailored to the local population. A large black and minority population will need sickle cell services; a young population will need more maternity and child services. Unplanned and irrational differences in provision may be unacceptable. Planned differences are not. The operating framework offers a possible solution: a core of national non-negotiable provision, a penumbra of services susceptible to local discussion.

We need to reassure ministers and the Department of Health that localisation is usually the result of good practice. We need to support them in rooting out irrational differences in provision and support differences that spring from local needs and local views.

Dr Brian Fisher, chair, Socialist Health Association

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