Tim Montgomerie, a Tory blogger, suggests in The (London) Times today,
p.25. that a footballing (soccer) metaphor helps us understand the
evolving governance of the health-care system in England. The
(English) Health Secretary
Jeremy Hunt is planning to be "the Chairman of the whole Premier
League" (read, whole
health system) rather than being involved at football club level (read,
involved with provision.) Quite apart from the fact that this metaphor
may come to haunt the Coalition - the Premier League is a breakaway
league founded on a desire to avoid redistribution of profit to the
weaker 'providers' in football! -  the depiction of Hunt's strategy as
out of Star Trek - to boldly go where no Health Secretary has gone
before - is actually based on ignoring the last thirty years of health
reform in England.

Since Sir Roy Griffiths' report in 1983, there have been at least four
attempts to take the Health Secretary out of the frontline, as
'Chairman of the Board'. All have failed. And there are good reasons,
as well as poor excuses, for this. In a nutshell: unless the
architecture of (to use the vogue lingo in today's England)
'commissioning', 'regulation' and oversight of
health services is finely-tuned to the complex needs of provision for
populations - including the need for integrated services
planned over networks - it is facile to assume that individual hospital
failings are local management failings.

The Francis Public Inquiry, due to report in January, is specifically
about this 'architecture.' I will be interested to hear if Jeremy Hunt
and David Cameron will pledge now to implement its recommendations
unless they are "bonkers", as Cameron infamously promised regarding
the Leveson Report into the press behaviour.

Hospitals are not schools, where parents make stable choices based on
predictable needs for years (ie their children's education), and so
are less amenable to market architecture. Moreover, to put it bluntly,
bad schools do not usually kill people. To say that Hunt is 'doing a
Gove' (copying the popping-eyed, bushy-tailed Education Secretary) is
no doubt correct. But it simply shows that health policy is
woven from spin and superficial plausibility.