The health secretary is right to link investment to accountability, but he must be wary of creating perverse incentivesFor any government contemplating NHS reform, the 2012 Health and Social Care Act is a textbook case of what not to do. Despite promises of “no more pointless reorganisations”, the Tory health secretary Andrew Lansley did just that, abolishing management tiers and imposing new care commissioning and competition systems on reluctant doctors.The whole thing was a political nightmare that wasted resources, demoralised staff and undermined public confidence. In an independent report published earlier this year, Lord Darzi described the Lansley method as “scorched earth”, from which NHS management capacity has not yet fully recovered. And that was before the full social cost of austerity had weighed on the health service, and before it had been battered by the Covid pandemic.Do you have an opinion on the issues raised in this article? If you would like to submit a response of up to 300 words by email to be considered for publication in our letters section, please