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Editor's blog Wednesday 1 July 2009: an interesting idea from Lord Darzi - budgets for clinical teams

Here is an interesting idea from Health Minister Lord Darzi, given to The Guardian today in an exclusive interview, about giving acute clinical teams control over their own budgets.

It's genuinely interesting. It could just be a means to real clinical engagement - or it could be a Machiavellian scheme to both stop their mouths with gold and to make them as complicit as a 'blame hound'.

It is, inevitably light on details. What, for instance, will happen to clinical teams who burn through their budgets mid-year? How will this impact on the senior responsible officer status of the chief executive job - and on that of the finance director? Will Monitor wear this idea in FTs?

There thoughts are not, of course, reasons why the NHS should not consider and trial this approach. It could put a rock into the gaping chasm between managers and clinicians, for the brave to climb up onto and see if they can do things better. (Equally, not everyone will have any interest in running a budget).

Entitlements without enforecement details
The same is true about the ridiculous 'policy relaunch' announcement to Parliament that 18 week maximum waits, and two for cancer (failing which, there will be recourse to private sector capacity that may or may not exist), will become 'entitlements'. There was no detail on how entitlements will be enforced. Of course.

A government with lots of lawyers at senior positions is clearly expecting both a thorough kicking at the general election and also a return to lucrative practice in the old job, with the public service reform announcements of turning targets into 'entitlements'. Because there is not a whisper on how they will be enforced, lawyers will have a field day. (Admittedly, it's not quite as silly as what Ed Balls has done on schools (opinion survey, parent consultation, leading to ... more consultation), but you'd be in competition with a master there).

Pronouncing precise entitlements is problematic. The NHS is not an insurance-based system (and those systems see a lot of gaming and redefining if clinicians disagree with thresholds). You end up with NICE recommending the NHS fund just one course of fertility treatment (which for many, just won;t work). Reducing unacceptable variation in clinical practice and outcomes is a good thing, but setting entitlements down on paper

in the interview, Darzi condemns London to another generation of no hospital closures as he puts matters into full retreat from any reconsideration of any DGH anywhere, as had been hinted at by Andy Burnham in his Confed speech. Well, there is an election on the way, so talking about closing anything anywhere, no matter how poor or wrongly sited, is clearly off-limits.

Enough already. Off for a glass of white wine and a watch of tennis as the barbecue cooks. Have a good evening.