More services could be commissioned regionally

Last time it happened - the health sector reforms that created clinical commissioning groups (CCGs) - it cost several billion pounds, caused chaos for years, and left almost all the same managers in post, but with different job titles. But it is happening again now, in a town near you.

The main driver, of course, is the relentless march of austerity. All the easy reductions were made years ago - the expansions under the golden age of Every Child Matters, the children's centres, the full service schools, the youth services. Middle manager posts have been cut in all agencies, as have most of the jobs focused on joined-up working and workforce development. The next round of savings either comes from cutting the front line even deeper, or from rationalising management structures. It is hard to argue against having a robust look at whether any structures are surplus to requirements.