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If nothing else the creation and performance of NHS England has demonstrated that attempting to form a single national solution to deal with imposed running cost allowances does not work, with NHS Property Services and CHP helpfully providing two more examples.

Perhaps then the answer is to go back to more local solutions and approaches. Simon Stevens managed to get primary care back together with other commissioning without the media really noticing. Specialised commissioning is on-going, which leaves Public health as top of the to do list.

Perhaps estates is next on the list?