In choosing between these options it has to borne in mind that strategic planning for individual speciality services or sub-specialty services is quite a different matter from the strategic planning needed to identify and meet the comprehensive health needs of a population. The NHS in Scotland must not perfect arrangements for the former at the expense of coherence and responsiveness in the latter. It is important to emphasise that most of these elements cannot and should not be determined in isolation. Indeed it is often the co-existence of these factors and the constraints which militate against change which make orthodox strategic planning so difficult to translate into effective action. There are a number of operationally important issues which can often complicate strategic analysis and the identification of practicable ways forward.
Planning operates along a spectrum.
Although the NHS Management Executive might be able to lead high level specialty-specific planning for a very small number of specialties it would probably find itself in some difficulty if it was required to lead strategic planning across a wide range of specialties. It would certainly find its capacity strained and its performance management role compromised if it got drawn into making choices about service priorities for local populations or intervening to resolve tactical problems. It is of course open to the NHS Management Executive to sponsor the formation of Standing Committees, Task Forces and the like, to exercise a strategic planning role on its behalf. However, such agencies would still need to address the question of how best to engage with local perspectives. As discussed in the Review, the professional view emerging from some quarters is that acute hospitals need to serve a population of around 450,000 to 500,000 to sustain the viability of some of their more specialised services.