whim and change. This
board would be accountable but capable
of delivering long-term planning and
effective reconfiguration if needed
and appropriate. The CSAG study and
implementation has struggled; it has
had to deal with three governments,
numerous different ministers and
a constant stream of civil servants
each unsure of their tenure, previous
decisions and future strategy. This
does not apportion blame, it highlights
an unwieldy and ineffective system to
deliver change identified by need. As
Sir John Butterfield said, "the medical
profession, like the great amoeba it is,
absorbs important ideas and changes. It
does not despair or die. I believe good
professions must breed elements of self
criticism, be outraged by the 'pups' they
spawn, react to them, albeit slowly,
sit up, bandage the corporate ego,
convalesce, rehabilitate, and move on
again, though in a different way.?"
We need more efficient systems to
deliver change, particularly when driven
by hard evidence and clearly identified
need. Most importantly, we need these