Editor's blog Monday 23 May 2011: Culture, strategy, breakfast: committee stage encore and collaborative Monitor?

Good morning. The Financial Times's George Parker and Nick Timmins report that government lawyers have been asked to consider whether the amendments to the Health And Social Care Bill currently under negotiation are so substantial that the Bill must repeat the committee stage scrutiny.

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As Parker and Timmins rightly note, "That would add months to the timetable, and would put in jeopardy – for example – the planned abolition of strategic health authorities in April 2012.". They report sources in Number 10 saying that no final decision has been taken, but what this evidently shows is that the Bill is to undergo a major rewrite.

It will, however, stop short of the excision of Section 3 on Monitor and competition (which Labour has sought), and Timmins has interviewed Professor Chris Ham of the Kings Fund, who supports the creation of a Monitor which takes what Ham terms a "nuanced and proportionate approach that encourages both collaboration, and competition where appropriate". [The Kings Fund has also published its response to the listening exercise, Where next for the NHS reforms? The case for integrated care, which (as its title suggests) promotes integration and collaboration.]

Culture's strategic breakfast
This is intriguing, because while the legislation is important, the behaviours and staffing of any competition-regulating Monitor are crucial. If Monitor is staffed with fundamentalist competition-heads, as its CE Dr David Bennett's Times interview gives good cause for concern may happen, then Monitor's behaviours, culture and thus definitions of what is reasonable and proportionate will follow from that.

There is also the small matter, as Parker and Timmins note, that Lib Dem Deputy Prime Minister Nick Clegg is understood to have committed to Monitor not being established as an economic regulator, in accordance with Clause VII of his party's official health policy.

However, as I wrote last Wednesday, the language of the document is interestingly nuanced. Not to make "the decision to establish Monitor as an 'economic regulator'", in the words of the Lib Dem-leaked text signed off by Clegg, in no way prohibits altering Monitor' s remit to become an economic regulator in a year to two. Such a change should still require primary legislation, but is a 'nice guy' Monitor is created to pour oil on troubled waters, that might help.

It's an interesting set of circles to try and square.

But nothing matters more than how the money works. You follow the money to see where the power lies, in the NHS just as in real life.