(There were a number of interesting tweets and comments about yesterdays post on the necessity for a strong centre in the NHS. Many of them argued that there is a false dichotomy between the ‘either’ of centralisation and the ‘or’ of decentralisation. They pointed out that large organisations need both. They need attention paid to a strong centre and to strong outward facing local service delivery.

Having established that they also need to pay attention to how these two forces – pulling as they do in different directions – can pull an organisation apart. Therefore it’s vital to know all the time not only that you are doing both –centralising and decentralising – but to pay very careful attention to how you are doing it.