Can Monitor chair Bill Moyes and KPMG consultant Kate Barber explain what is new about the 'The new economics' and justify the statement: 'Treating individual services as profit and loss units promises to transform financial management and clinical engagement' ( HSJ, 16 November 2006)?

Can Monitor chair Bill Moyes and KPMG consultant Kate Barber explain what is new about the 'The new economics' and justify the statement: 'Treating individual services as profit and loss units promises to transform financial management and clinical engagement' ( HSJ, 16 November 2006)?

From the early 1990s I worked as an NHS manager, having previously been a radiographer. From that time my managerial and clinical colleagues managed income, expenditure and budgets at clinical directorate level within one of the country's largest acute teaching trusts. This included the development of service-level agreements between both clinical support and central management functions. These agreements were initially tested in shadow form to allow us to fully understand their implications.

The information we had to work with was often incomplete but specialty teams met regularly to discuss activity levels and identify areas where changes to both front and rear-line services could lead to service improvements and economic savings. We longed for improved information systems to allow us better to understand both the flow of patients and every aspect of their stay within the hospital.

I fail to see the difference between that and what is now proposed.

Is the NHS in danger once again of failing to learn from past experience and spending much needed money on reworked management ideas? No doubt the implementation of these 'new' ideas will need to be supported by expensive management consultants.

Linda Kennedy, independent management consultant