Editorial Tuesday 21 May 2013: Exit Comrade-In-Chief Sir David Nicholson: who inherits the Earth now?

Hello. I'm back.

I've been a bit busy with some other things, like becoming Comment Editor at Health Service Journal. I'll do a longer piece about my conflicts of interest when I can, but here it is.

And speaking of things that are here, Comrade-In-Chief Sir David Nicholson is off come next March, to the enormous surprise of absolutely nobody.

The Comrade-In-Chief's resignation letter to Chairman Mal is here, in which he says "the new ways of working are now taking shape, and I have therefore decided that in March 2014, after two years in the post, I will retire as CEO of NHS England". He opens the final paragraph with "whatever the rights and wrongs of the wider reforms", just in case anyone were uncertain as to his views on the advisability of the Lansley reforms.

A Titanic policy failure
Just as the Titanic was infamously intended to be unsinkable, the Lansley reforms to liberate the NHS were intended to be irreversible - a final settlement.

Oops.

That heroic faith scarcely survived contact with the top-down reality of the NHS Commissioing Board's mandatory national imposition of NHS111, leading to the well-publicised near-inevitable foul-up.

Nor has it survived Health Secretary Jeremy 'Bellflinger' Hunt's determination to take a fairly close operational interest in the NHS, with heroic struggles by NHS England to prevent Hunt announcing new money to buy off A&E performance problems.

Who's next?
They say 'the meek shall inherit the Earth', although in my experience, the meek mainly inherit the bill. All the same, it would be remiss not to join in the wild speculation about who will succeed the Comrade-In-Chief.

There are some candidates whom the NHS simply cannot afford (as this will be a new appointment, presumably limiting it to the Prime Minister's £142,000 a year salary).

This alone will almost certainly rule out both UnitedHealth's Simon Stevens and KPMG's Mark Britnell - proabably the two most commonly-dropped names as putative NHS chief executives-elect. Even if Comrade Sir David's £250,000 were on offer again, that's probably a six-month business travel budget to either man.

It seems likely that Mike Farrar of the NHS Confederation will again throw his hat in the ring, as may NHS England's director of commissioning Dame Barbara Hakin. The outstanding GMC complaint by Dr Phil Hammond and Andrew Bousfield against the latter creates an interesting dynamic.

Duncan Selbie has the central experience, and got out of the way of trouble at the right time in previous roles. Is Public Health England goinig to be too engrossing a gig to relinquish him?

A clinically-led NHS, you say? Try Lord Darzi of Denham, whose near-support for the Health and Social Care Act is not likely to havge ruled him out - but does Darzi want to spend time away from his surgical robots? Probably not likely.

NHS England medical director Sir Bruce Keogh showed courage in stopping child heart surgery at Leeds promptly over safety fears. He would be popular with many clinicians, given his role in the publication of cardiac heart surgery data. And he's already on the payroll.

Professor Aidan Halligan, former deputy chief medical officer, will probably not even be considered because of his 2006 "any suggestion of real reform is a deceit: working patterns, practices and customs are at the heart of many capacity issues, and have never been challenged" article for me in the post-Crisp issue of British Journal of Healthcare Management told the truth, and thus cost him his job. Subsequent events have proven Aidan more or less totally right, but there you go: a prophet without honour.

It comes too early for Dr Mark Newbold of Heart of Birmingham FT, but he has an understanding of how the system is changing and must change yet further that could prove valuable.

A clinical commissioner, did you say? What's that? You didn't say? Oh. OK, then.

Other runners and riders: how about an experienced money man, in NTDA boss David Flory? Interesting that the job of NHS England finance director did not attract him.

Private sector imports? Ali Parsa? Erm, no. Jim Easton? No, althoough he may well apply.

Front-line staff
Of hospital bosses, Sir Robert Naylor, UCLH CE, would not be a bad bet with his fairly flawless track record of success, but could he stomach the bureaucratic idiocy? And would he want to work in Leeds?

I would greatly like to see Paula Vasco-Knight of South Devon Healthcare Trust in the mix: a talented clinician, who has invested time and effort in the Torbay health economy. She would be a welcome change, and a break with the ancien regime.

But my tip would be Peter Homa, CE of Nottingham University Hospitals. He enjoys the respect of his peers, hasn't fouled up anywhere, and has the valuable triangulatory experience of his tenure of the initial incarnation of CHI. Being endorsed by Health Policy Insight may be a hospital pass of epic proportions - but if Peter were to want to apply, he is now so burdened.