Health secretary Andrew Lansley has said devolved clinical decision making is a ‘threat' to organisations which would prefer to have decisions made at the centre.
He told a question and answer session in London last week: ‘I find it slightly bizarre that I'm trying to disempower the central bureaucracy and the Secretary of State (with their) constant interference and people keep trying to push it back.
‘In my experience the people who are trying to push it back are the people who are most likely to have a vested interest in decisions being made at the centre – so look very carefully at who is saying what and why because I actually think devolved decision making and clinical decision making is a threat. It's a threat to organisations that like to have all the decisions made by the bureaucracy at the centre.'
Mr Lansley was responding to a question from former NHS medical director, Dr Graham Winyard, who is now chair of Winchester Liberal Democrats.
While commending, Mr Lansley's commitment to outcomes, Dr Winyard said: ‘The bit of the picture I just cannot understand is why to take things forward we require structural reorganisation and why all the people you're empowering seem so relatively unenthusiastic about it. Isn't there a message there?'
The question and answer session, organised by the Smith Institute in association with the Asthma UK and the Association of Chartered Certified Accountants also saw Mr Lansley defend those CCGs which did not with to be coterminous with their local authorities.
He said: ‘I do feel very strongly we have to trust commissioners to come up with this.
Because a CCG might be smaller doesn't mean it has to do everything themselves. There was an abiding theme in PCT land, that you've got to have all the capabilities in house or buy them in from management consultants. Actually, we've got to use the flexibility we've got with strong national commissioning for specialised services and quality standards and local CCGs.'
He added: ‘The NHS has spent decades trying to arrive at a place where all the intermediate organisations are the right size for every purpose and you can't do it.'