"It is not good management to say 'you need to cut costs by £15 billion; go find the savings. It is good management to say, 'we need to cut costs by £15 billion, and here's how we might do it'. Without this 'here's how', managers are not managing. They are posturing".

Independent challenge has never been wildly popular in NHS health policy, to put it mildly.

Liberating The NHS originally promised much more independent challenge - though as our analysis of the DH response to the White Paper consultation pointed out, quite a few of the proposed freedoms (especially for Monitor) are deferred or dropped, and the Secretary Of State’s role is to be much less diminished than promised.

It's very tempting to refract all of NHSland and health policy through children's television.

There are too many parallels for comfort: strategic health authorities as the large and largely pointless Haa-Hoos from In The Night Garden; GP practice-based commissioners as Bagpuss - "and when Bagpuss wakes up, all his friends wake up too!"; and SoS Lansley as, well, La La from the Teletubbies.

Regular readers know our views on the Government's absolutely discriminatory, NICE-undermining National Cancer Drugs Fund: not only is it a crap idea, it is a populist crap idea.

Thinking about the response to the White Paper consultation and the 2011-12 Operating Framework, I've come to two conclusions.

The first is that either the people who wrote this lot are very confused indeed, or I am. Perhaps both.

The second is that it all means the NHS is going to be Safe As Milk. I'm just not clear what kind of milk we are talking: farm-fresh; UHT-insipid; or sour, rank and turning mouldy.

The big one in the 2010-11 NHS Operating Framework is the announcement of competition on price, with tariff as a maximum.

The iridescent Professor John Appleby of the Kings Fund noted it in his rapid response guest editorial last Thursday. Appleby subsequently deadpanned, "I'd love to see the impact assessment on this one".

TAXPAYER INVESTMENT IN FTs (6.24-6.28) – “The Government currently holds an investment stake of £24 billion in foundation trusts and NHS trusts, in the form of public dividend capital and loans; Regulating healthcare providers asked how this investment should be overseen in future, and whether there should be a role for regulation.

Are we going to get a remedial Commissioning Development Agency, to go alongside the Provider Development Agency for non-FTs?

There is some fascinating stuff in the various documents - for now, just have a think about this, from the consultation response and legislation proposal.

It means that in undefined "emergencies", the Secretary Of State For Health will gain power of direction over every commissioner and every provider - all NHS foundation trusts and all GPs.

So this is what is meant by liberation - nationalisation whenever the Health Secretary feels like it. With no defined end to "emergency", or apparent need to apply to Parliament to assume remove this power.

The iridescent Professor John Appleby is the chief economist of the Kings Fund. In this guest blog, he peers intently at the rises in PCT allocation issued today by DH and at the Operating Framework.

The harder you stare at the PCT allocation figures for next year, the less you see.

Less, not only in terms of clarity, but just less - as in the opposite of more.

Can’t avoid some numbers on this, so….

Total PCT revenue allocations next year will be £89.1 billion. This is equivalent to a 3% cash rise. This is greater than the 2.0% cash rise for the NHS as a whole.