We are all for the NHS looking at more efficient ways of doing things. If it means more people can be helped for the same money, then it has to be a good thing.

We do have serious doubts about the wisdom of outsourcing jobs abroad. The Oxford Radcliffe Hospitals Trust has not said it is going to do this. It is clear, however, that it is an option in the NHS.

Teams of people based in the United Sates, India, or wherever in the world, are perfectly able to provide administrative support. But can they really provide quality support to services based thousands of miles away? The same could be said of teams based in Britain providing support to services in the United Ststes or India.

To work well, you need to have connection with the people with whom and for whom you are working. You also need to understand the service you are working for.

Would workers in the United States or India understand the uniqueness of the NHS and, modern communications notwithstanding, could they really build a rapport with medical staff and patients across so many thousands of miles? We remain to be convinced.