Editor's blog Friday 2nd September 2011: The closed culture of NHS management

The closed nature of the NHS's management culture isn't much of a surprise once you've been around it for over a decade. Tax funding with a single payer makes our healthcare political.

That said, we do have a lot of what passes for debate over politics in this country. Contrastingly, NHS management has some considerable debate-aversion.

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It is in fact striking when people speak out candidly, as Roger Boyle has done recently.

Or of older vintage, when Professor Aidan Halligan wrote a piece for me during my eight-year stint editing British Journal of Healthcare Management (eight years; you get less than that for manslaughter ...) which said, "We have learnt that throwing money at the problem only allows us to do more of what we have always done. Any suggestion of real reform has been a deceit: working patterns, practice and custom are at the heart of many capacity issues, and have never been challenged.

"Though their introduction was courageous and appropriate, targets have become an
end rather than a means and, together with blinkered performance management, have distorted health care priorities and prompted initiatives built on little clinical understanding
and massive over-management", it was wholly clear that Aidan was ready to leave the employment of the DH.

We are entering the time of the Nicholson Health Service. Comrade Sir David's public utterances repeatedly warn people against becoming 'commentators', which may reflect his longstanding support of may be a fan of Nottingham Forest Football Club.

The next two years will be a centralising phase, that will see essentially all power transferred to the NHS Commissioning Board and Monitor (whose interesting route to being the NHS economic regulator comes via being a market-maker and failure-suppressor we discussed yesterday).

The