Editorial Thursday 12 July 2012: Thoughts from a boardroom

I was privileged to be asked to give a talk on health policy and politics to today's meeting of the Board of Trustees of Macmillan Cancer Support.

They have a very serious group of people, who heard me with great courtesy (all the more so since I over-ran the allocated time).

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I don't suspect I told them many things they didn't know, but the quality of the Trustee's questions was so good that I thought I would summarise them (Chatham House-style).

1. Which are the gold standard commissioners - who are the best in the world at this?
I outlined the view taken by Professor Alan Maynard and others that the commissioner-purchaser function is not particularly strong in any of the developed world's health systems.

It's a fantastic question, and one I couldn't pretend to answer.

2. How will the NHS Commissioning Board prove that it really is independent?
I could get somewhere near this one: by having a prominent row with its antagonist at the earliest genuine opportunity.

It seemed to me that there is some degree of a valid parallel with old-school Monitor under Bill Moyes' chairmanship: Monitor had an authorisation function and also took no backwards step when ministers or the Department tried to encroach on its turf.

3. When will the Commissioning Board first make a case that the NHS is not sufficiently funded?
I said that the service is currently suggesting that the money will broadly be OK for 2013, but is starting to describe 2014 with the word "bloody".

So this is not likely to be in 2013 - but I also suggested that Professor Malcolm Grant - Chairman Mal - does not see his role as being to argue for extra NHS funding. That is for politicians to do, in what I understand to be Chairman Mal's world view.

More to the point, more for the NHS means less for the rest of the public sector, which has had harder hits so that the NHS enjoys its relative protection.

4. Will clinicians get a hold of these changes and make them work?
Some undoubtedly will, I suggest, but commissioning is hard to do (as PCTs found) and CCGs are being asked to create themselves very fast indeed.

I offered my view that on average, clinicians may be harder to bullshit than managers were about the clinical cases for or against change, and perhaps more proactive in reforming pathways of care and decommissioning the obsolete.