Editorial Thursday 11 June 2015: Monitor and TDA to sort-of-merge as David Bennett exits

And one of the worst-kept secrets in the NHS is revealed: Monitor and the TDA are to sort-of-merge. Both organisations will continue to exist legally, but there will be a new chief executive appointed by both boards.

And it will not be Dr David Bennett.

Dr Bennett feels that he has been fighting a rearguard action with Jeremy Hunt on FT performance for too long.

It is a couple of years now since Monitor as an organisation got real to the fact that much FT overspending 'misbehaviour' is due to height of demand and shortage of trained staff driving up costs.

Consequently, Monitor slowly admitted internally, and latterly externally, that its traditional response of foisting failure regimes and management consultants onto troubled FTs, often sacking CEs and boards en route, was about as useful as a one-legged man in an arse-kicking contest.

The 'one-legged man in the arse-kicking contest' is a pertinent image for system leaders to keep in mind as they try to design a less inept response to provider problems caused by systematic problems. We shall see how that pans out in the 'success regime'.

Heat transfer
When badly handled (which is often), the politics of bad news transmission in the NHS are ductile where they should be plastic: able to move under stress without fracturing.

The bad news transmission process is uncomplicated in structure. The Treasury transmits heat directly to Jeremy Hunt for NHS overspending.

Jeremy Hunt then radiates that heat to proider chief executives, and to Dr David Bennett in the case of FTs.

Dr Bennett has probably got enough money in the bank to no longer need the kind of pressure he has been getting from Jeremy Hunt for the past eighteen months. He was holding on to see if a different secretary of state would result from the general election.

That didn't happen, and Dr Bennett is gone by the end of the year.

This is a bit of a shame, as Monitor's dawning realisation internally over the past couple of years that it was much less the FTs than the tariff and system had moved the organisation to a far more helpful position.

Hopefully, its board are on board with the need for Monitor to develop a supportive, learning side.

A few questions
Monitor is supposed to have developed Chinese walls between its tariff-setting statutory role and its equally statutory duties in provider financial oversight. The 15-16 tariff debacle does not hugely show that they are effective.

With a sort-of-merged TDA on board, the TDA will be supervising the very providers that Monitor is assessing for FT status (and it is not inconceivable Dr Bennett's replacement will be set targets for getting trusts into FT status). How will the building of Chinese walls on Chinese walls work?

Then there's the money. We know the NHS money is in a mess, but after the Health Secretary's recent letter to CEs about Very Senior Manger salaries, the £142,500 Prime Minister's salary will look like a pretty firm benchmark.

Any serious candidate will already be aware that Dr Bennett has beren earning £230,000.

Form an orderly queue.

UPDATE: actually, there's an obvious candidate to replace David Bennett: Grant Shapps. Right politics; demoted in the reshuffle; adept at juggling differing identities for respective audiences/boards. What's not to like?

The perfect candidate if anything ever needs an over-firm denial, in fact.