Abstract
I strongly applaud the constructive opinion of Ladds and Pereira Gray on the management of the NHS. 1 It is clear that the megalithic structure of the NHS with its autocratic ‘top-down’ tsunami of diktats from ‘Moscow Centre’ is no longer appropriate. I have long reflected on an alternative and am convinced that giving independence to regional health services is part of the solution: I would much rather be a patient of ‘East Anglian Health’ than the NHS, although clearly funds would still be allotted from central government. Funds should be strictly awarded on a per capita basis without divisive fudge factors. One would predict that differences would emerge in healthcare between different regions but that would be healthy competition which would encourage improved standards. A study of the Canadian model of devolving healthcare to provinces would be rewarding. I predict that devolvement of healthcare to regions would improve staff morale and patient care.