Sir Ian Carruthers' two-month review of England's reconfiguration proposals urges much greater co-ordination of effort - a more united front to replace a series of skirmishes.
The NHS South West chief executive has been careful to praise the general quality of reconfiguration proposals, although he also says strategic health authorities have to 'raise the bar'. Reading between the lines, some of the consultations were still below the level he expects in a modern health service.
There is too much variation - whether in overall quality, style and structure - even when consultations are geographically very close, he says. His recommendation that SHAs employ the Gateway process, used by the Office of Government Commerce to quality-assure major public procurement, is a long overdue attempt to establish a system that provides coherence without stifling local flexibilities. The method is sound; how it performs will depend on the skills of the SHA in question.
Sir Ian also recommends that primary care trusts, as the planners and commissioners of local services, should lead reconfiguration in the patch - this will inevitably mean they are determining not just the communication but the strategy as well. Keeping the stakeholders together in those circumstances will be a challenge for some PCTs.
Sir Ian's 'sense check' of consultations provides a valuable service. But why has it only happened when many of the consultations were already up to their knees in mud in local conflicts? It will be scant consolation to them that the next war will be fought more effectively.