Health Secretary Alan Milburn’s vision of ‘Real Localism’ includes limits on the size of Whitehall and a re-balancing between the power held by central government and the power held by local communities. This vision comes hard on the heels of Chancellor Gordon Brown’s prediction that the next decade will see the biggest ever shift of power from Whitehall and Westminster to the regions and local communities. This will mean Britain moving away from centuries of being weakened by centralisation to become a country strengthened by local centres of initiative, energy and dynamism.Alan Milburn believes that the time is right for a fundamental re-assessment of what functions Whitehall needs to perform in an era where the premium is now not just on making policy but on securing delivery. The days of Whitehall knowing best are over.

Speaking about public services in the 21st Century he said: “The relationship between citizens and public services should be based on principles of decentralisation and empowerment. In health, in education, in housing, in local government and elsewhere we need to decentralise and empower staff and citizens alike. We must decentralise from the nation to the region. We must decentralise from local councils to local schools and to local housing estates. And in the NHS we must give communities more voice as well as giving patients more choice.

In the context of the NHS he added: “It cannot survive as a monolithic top down centralised system. Without greater diversity the NHS cannot be more responsive. Without responsiveness there cannot be public confidence. Without public confidence the NHS will not be sustainable.