The NHS is not focused on user satisfaction. Until it is, no wonder some people say they are worried about relaxing targets. A survey of 3,000 members of the public by research agency OnePoll (PR Week 25 June 2010 http://www.prweek.com/uk/news/1011885/Reputation-survey-National-Health-Service—Public-pans-A-E-plan/) should cause Mr Lansley to consider possible risks to his and the NHS’s reputation. Answering the question “which is your biggest concern about the NHS?”, the pollsters claim that 73% of respondents said scrapping the 4hr AA&E waiting target (now down to 95% achievement from 98% but with no performance management) was only a money saving measure unrelated to improvement in patient care. 64% wanted the target retained.

Of course, polls may tell us nothing, or at least nothing worth knowing. But public anxiety about relaxing standards can percolate to the surface very quickly. If it does about changes to NHS services, Ministers may find it hard to deal with. Perhaps that is why they are keen to establish the mooted independent NHS Commissioning Board, in order NOT to have to know and be expected to respond whenever someone drops a clanging bed pan on the ward (with apologies to Nye Bevan).