Somebody within the health service must take responsibility for checking the bigger picture, argues Mr Strachan.
He wants a small group of strategic health authorities or a commissioner – not a regulator from outside the NHS – to keep sight of that larger picture.
But he points to the fact in two years’ time health spending will have risen from £35bn to £100bn.
The emphasis of reforms must be as much on changing behaviour – such as ensuring patients are met by a smiling receptionist – as on changing structures so they mimic the mechanisms of the marketplace, he says.
Payment by results – where money follows patients around rather than hospitals being paid lump sums – is one of those market mechanisms.
The government is forecasting a £620m deficit for the NHS in England for this financial year and surgeons in some hospitals have been told to delay operations to cut their debts.
So is the payment by results policy the reason for these cash shortfalls?
Local councils are among those who complain about the burden of regulation but Mr Strachan proudly says the amount of Audit Commission-controlled inspection has fallen 70%.