It is somewhat ironic that the prime minister, who wanted to be remembered as bringing self-generating service reform to Britain's public services, should have ended up presiding over a health service that is being run in a more centralist fashion than when he took office.
Elected members and chief officers in local government may chaff at the intervening and ever-present hand of Whitehall, but it is a pale reflection of what has been going on in the NHS of late. 
As I go around the country, I hear of PCT and hospital management teams ‘summoned' to see their strategic health authority to account for their performance, or to receive their latest instructions.
Chief executives who are deemed to be failing – or, more usually, not improving fast enough – are moved on with scant regard, it would appear, to the formal governance role of local trust boards. 
Never mind what might be in an LAA.
What matters is performance against the so-called Selby six targets. These do include health inequalities in the form of a smoking-cessation target, but they major on NHS delivery:

And all this has to be done within the context of making the books balance. Now, these are all good objectives – it is the right policy agenda.  But the overweening way in which SHAs are pursuing these ends has a number of serious implications for local government.
It means PCT chief executives, many of whom have often been in post only a few months, are often cautious about wholeheartedly committing themselves and their organisations to partnership working. 
All the time, they are looking over their shoulder at what the NHS hierarchy will make of their actions.  They are afraid of getting the chop. 
And fear is not a sustainable basis for either delivering sustainable improvements in service or building strong partnerships.
Even more worrying is that despite the move to NHS Foundation Trusts, which supposedly have greater financial and operating freedoms, and the development of Foundation Primary Care Trusts, the NHS is strengthening, not relaxing its centrally-driven management of the health service. 
The chief executive, David Nicholson, comes from a traditional command and control NHS background.
And in the last month, he has set up an NHS leadership team – which includes all the chief executives of the SHAs – to tighten the grip of the centre on the rest of the NHS. 
And just to compound matters there is talk of further structural upheaval – of further PCT amalgamations where the ‘big is beautiful' brigade did not get all of what they wanted last time around. 
The folly of the approach is that the NHS cannot deliver much of what it aspires to achieve – whether in terms of health improvement or reorganisation of hospitals – without the engagement and support of local partners and local communities.
All in all, a pretty depressing picture. Except, in some ways, it isn't.
Despite the NHS's best efforts at co-ordinated centralism, good local initiatives are growing. Joint appointments between local authorities and PCTs of directors of public health are increasing, as are examples of having shared directors for commissioning children's and adults services. 
In some areas, PCTs have bravely made clear their intention to free up money on reducing health inequalities and spend the investment in accordance with a strategy agreed with their partners.
In other areas, joint commissioning is becoming the de facto way of doing business. Yet these examples are happening despite, rather than because of the system.
The new LAA will be doomed to failure unless the NHS mends it ways. 
But, as well as arguing for a more place-centred approach, localities might also be able to use one of the Government's own measures to turn the centralising NHS tide. The local government and public involvement in health care legislation will require local authorities and PCTs to work together to produce a strategic assessment of the health, healthcare and social care needs of the local area. 
Clever and determined partners might just be able to take this statutory requirement and turn it to their advantage to resist unreasonable top-down pressure.
Robert Hill is a former health adviser to Tony Blair. He now works as an independent consultant