Editor's blog Wednesday 10 November 2010: Faster or slower change? Is Lansley ignoring Nicholson?

This is a puzzle.

Earlier today, I heard about David Nicholson's National Quality Board letter to Health Secretary Andrew Liberatin' Lansley, which urges a measured approach to the pace of change, moving to the new system once bodies are demonstrably fit for purpose.

Now Dave West and Sarah Calkin of Team HSJ have spotted that the DH has issued a revised timetable, bringing precise end-dates for PCTs (April 2013) and SHAs (April 2012).

NHS CE David Nicholson to Health Secretary Andrew Lansley: 'it will of course be important to make sure that the formal transfers of power between old and new organisations are guided by a clear assessment of a new organisation’s readiness to take on new responsibilities'.

It is as if the left hand does not know what the further left hand is doing.

Nicholson's letter to Lansley (dated 1st November) stated, "Implementing the White Paper will require us to strike the right balance between developing early momentum for change and allowing enough time to properly test the new arrangements. Getting this balance right will be critical to maintaining quality and safety in the short term ... it will of course be important to make sure that the formal transfers of power between old and new organisations are guided by a clear assessment of a new organisation’s readiness to take on new responsibilities".

Earl Howe reportedly told the all party parliamentary group on primary care and public health, “I think it’s right to set that goal. If we don’t we will lose some of the best [PCT and SHA] people… If we drag this out they will go. What we are trying to do is identify roles for those key individuals now”.

Nicholson's letter also suggested that the relationship between the Health Secretary and the NHS National Commissioning Board should be seen as akin to that between the Chancellor and the Bank of England.

Which is all well and good as a metaphor, but the BoE has a big, blunt tool called interest rate setting. It is financial decision-making, writ large.

Contrastingly, the DH updates confirms that the Liberated NHS is going to leave financial decision-making power squarely in the all-powerful economic hands of Super-Monitor; “responsible for setting efficient prices ... (its) licensing regime operational” from April 2013.

It seems that The Liberator is a Fugees fan.

I wonder whether David Nicholson thinks it's ready - or not.