'Why instability is inevitable' - Simon Stevens' article on the NHS and the J curve (page 19, 19 October) reminded me of a classic false syllogism: 'It always gets worse before it gets better.It certainly is getting worse. Therefore it will get better.'
'Why instability is inevitable' - Simon Stevens' article on the NHS and the J curve (page 19, 19 October) reminded me of a classic false syllogism: 'It always gets worse before it gets better.It certainly is getting worse. Therefore it will get better.'

Mr Stevens' belief that the current difficulties in the NHS are an inevitable consequence of the giving up of central control, and suggestion that they are a necessary stage in the process of moving from a 'closed' to an 'open' system, flies in the face of the facts.

There are many reasons for the current 'instability', but the timing of the present problems surely arises from one part of the centre (Number 10 and the Treasury) telling another (the Department of Health) to stop taking the mick. If creating an open, devolved, market-led system was what was actually happening, it probably would have been preferable to avoid reorganising PCTs right in the middle of that reconfiguration, and also before the new market architecture was in place.

In fact most of the current reconfigurations are the result of regional initiatives, and the shakedowns in providers are because of sharing out historic deficits - all very old style. This is surely also a comment on the confidence that the centre has in the new mechanisms for managing demand - the idea now appears to be to sort everything our before we introduce them.

Simon White,
Social care consultant