The inception of a single provider, hub and spoke variant to this model, in which a central employing Trust (NC) provided services to six others, was a relatively new development driven by rising TB rates, serious outbreaks of drug resistant disease, needs to rationalise service level agreements, flexible deployment and co-ordination of services.
But his tax cuts amounted to much less than the promised C$1 billion ($850m) a year, while the attempts to rationalise services were often unpopular.
I had a glimpse this week, sitting on The People's Inquiry for London's NHS looking at the capital's rudderless attempt to rationalise services.
The schemes, which are likely to prove highly unpopular, are being put together as part of NHS England's drive to rationalise services and treat many more patients outside hospitals through 44 regional Sustainability and Transformation Plans in a bid to find £22bn of savings to help close a £30bn hole in its budget.
On the Metropolitan Railway (renamed the Metropolitan line), Pick and Ashfield began to rationalise services.
He says it will only get harder for London Gateway to attract business, given that the world's major shipping lines are increasingly grouped in a limited number of alliances, which are already committed to existing ports and concentrating on rationalising their services, as their ships grow ever bigger.
The money would be needed so the NHS can dramatically rationalise hospital services, and concentrate its specialist and GP services – allowing an NHS Nicholson calls "unsustainable" to ditch its outmoded reliance on hospital-based treatment and switch to a new model of community-based care.
As for rationalisation, when two hospitals in Bournemouth and Poole proposed last year a merger to rationalise their services, the Competition Commission prohibited it; and plans to move the world-famous Papworth hospital to the biomedical campus at Cambridge are being blocked by the Treasury, which wants it to shore up Peterborough hospital's PFI-stricken finances by moving there instead.
The new plan also seeks to rationalise cardiology services offering medical treatment, but not surgery, to patients with heart defects.
The Gateway approach, which began in 2005, was held up as an example of how savings can be made by rationalising public sector services at the point of delivery, while simultaneously improving the client experience.
