Now here is An Interesting Things, brought to my attention by Lord Hunt of Kings Heath, Labour's health lead in the House of Lords (Temporal And Spiritual, for ever and ever, Amen).

Lord Hunt's fellow-lord, Lord Rea asked Buttle Of Britain Earl Howe for various details on the costs of commissioning support units (CSUs, of course).

Earl Howe gave a broadly correct response, but said that CSUs "employ around 8,500 staff and generate a total income of £750 million. A breakdown of these figures has not been provided because this information is commercially sensitive and might jeopardise a CSU's commercial position when competing for work from CCGs or other customers".

This is in fascinating contradiction to the messages in Health Service Journal's CSU News Klaxon Operative-In-Chief David Williams' recent exclusive, which heard from NHS England's CSU supremo Bob Ricketts that CSU privatisation was ruled out because “it doesn’t fit well with NHS values”. (You will recall that NHS England owns all the CSUs.)

Ricketts also told HSJ that NHS England would assess proposals for a private joint venture partner to have a controlling share in CSUs against possible risks: “we would want to retain a significant degree of control, certainly in the short to medium term … we’re not interested in private sector participation in its own right. We’re interested in private and voluntary sector participation where that can lever up the quality and value for money”.

Ricketts also told HSJ that while CSU leaders would draw up proposals for autonomy, Mr Ricketts said NHS England would check that CSUs had enough support from their CCG customers to remain viable.

It is difficult to reconcile Earl Howe's statement that details about CSUs as wholly publicly-owned and funded bodies are 'commercially sensitive' and Ricketts' clarity that NHS England does not see CSUs as operating in any kind of meaningful market.

The management overhead in NHS commissioning is supermodel-skinny. It is unlikely to be otherwise for some time to come. There has been some consolidation among CSUs, as David Williams' #CSUnewsklaxon has shown us. There is likely to be more, as the skills to do any kind of commissioning are in short supply. So is management overhead for CSUs' only potential clients, CCGs. (Earl Howe's view of CSUs as having other customers is fantasy.)

What is Earl Howe talking about, then?