Editor's blog Wednesday 23 February 2011: Stalin meets Heath Robinson

Hands up if you can explain the consistency of what’s going on in health policy?

No, thought not.

Within a week, we have had clarification of the U-turn on price competition by Sir David Nicholson; followed by denial from the DH that this U-turn was a U-turn (sure - maybe it was an artichoke).

This has been followed by That Nice Mr Cameron promising a “new presumption – backed up by new rights for public service users and a new system of independent adjudication – that public services should be open to a range of providers competing to offer a better service … the state will have to justify why it should ever operate a monopoly … we will also create a new presumption that services should be delivered at the lowest possible level”.

That Nice Mr Cameron then made ex-KPMG ”bleeding edge” payment-by-results-for-everything advocate Paul Kirby his health of policy development.

But apparently, That Nice Mr Cameron doesn’t mean it. According to anonymous briefing given to the FT’s Nick Timmons and Jim Pickard; he ”has scrapped the idea of a fixed proportion of public services having to be delivered by the private and voluntary sectors … not least because – as lawyers warned – it looked likely to fall foul of competition law”.

Timmins’ and Pickard’s source also stated, “If this becomes just about traditional privatisation, it will collapse pretty quickly”. They report tensions between That Nice Mr Cameron and deputy prime minister Nick Clegg on the extent to which the ending of state monopoly provision systems means traditional privatization, and also over what degree of  emphasis should be placed on the use of the voluntary sector and the promotion of mutuals.

Meanwhile NHS Supreme Soviet Chair, Comrade Sir David Nicholson has told Health Service Journal about his unique brand of liberation.

Nicholson-watchers will not be surprised to hear that his plans are for an extended period of grip over the budget, autonomy from which GP commissioning consortia will need to earn.

On the issue of whether consortia should make or buy commissioning support, Nicholson is unambiguously directive: ”Don’t create 20 different commissioning support organisations – create one big one.”.

Consortia’s chosen source of commissioning support will be crucial to full authorisation by Nicholson’s NHS Commissioning Board, which he promises will ” take an active role” in shaping the market for commissioning support.

Stalin meets Heath Robinson: a winning NHS reform partnership.