‘In a dark time, the eye begins to see.’ Theodore Roethke (1908-1963)
Reading McShane and Smith's BMJ article1 on a simulated exercise on how to cut expenditure, what becomes clear is how successive reorganisations of the NHS in England have created a creature of great complexity. The Department of Health, strategic health authorities, acute trusts, medical schools, primary care trusts, community health organisations, private companies, social care, commissioning and monitoring organisations, National Institute for Health and Clinical Excellence, and the Care Quality Commission are probably the main players. It's tempting to be cynical and satirise,2 but the tragedy for patients, …