In this Guardian feature by David Hare on the theatrics of Cleggmania, an interesting point is raised about the possible future of a more mutually-provided NHS.

Desrcibing Clegg’s appearance at the RCN Congress yesterday, Hare writes, “When offered the chance to rabble-rouse by a hugely popular questioner who asked: "If you are giving voters the right to sack their MPs, will you give nurses the right to sack their chief executives?" Clegg predictably turned it down ("I'm not going to sanction a lynch mob") before going off into some of the drivel – "I don't want you to sack the bosses, because you will be the bosses".”

In a mutual future, that would potentially be true – the workers could have equal democratic voices.

This doesn’t happen in all mutuals - as Charlie Mayfield, chair of the John Lewis Partnership, made very clear in his remarks at the Circle conference in February.

What the JLP have is the opportunity for front-line staff in branches to challenge and request explanation for management decisions.

What this raises, however, is a question about a massively unresolved issue: who is going to be the NHS manager of the future.

My suspicion is that we are going to need chief executives and senior directors who are brilliant users of data and informatics, and population statistics. They will also have to be sufficiently clinically knowledgeable not to be bullshitted by the medics. They will genuinely understand health economics.

The future CE will need negotiating and change management skills, in order to bring a staff team with them, and more importantly, to be able to generate a stakeholder corporacy about financial responsibility among all clinicians at all levels.

They will require serious public engagament skills, to be able to explain why closures could improve healthcare, and why healthcare disinvestments have to be made to put cash into preventative care and health improvement – where it can be proved to work and be sustainable.

Not many about, you might think. And I would be minded to agree.

Now here is a challenge if the future is mutual-shaped. The logic of mutualism seems to involve greater democracy (a massive cultural change for the NHS).

The workers in a co-operative would be very likely to be the bosses, if you take this to one logical conclusion.

So. If that happens, in your experience of the staff in the NHS, are they going to elect the manager of the future as a leader?

Or the popular person who’s going to mean an easy life doing more – or probably, less – of the same?