As the Secretary Of State For The Time Being's planned NHS reform gets kicked even further from its place in the long grass into The Pampas Grass Of No Return, now is the moment to acknowledge that the Nicholson Health Service [about which Health Policy Insight has written last July; again last July; last November; last December; this January; and again this February] is a reality.

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A wry smile must be playing around the corner of NHS Supreme Soviet chair Comrade Sir David's features.

Because it wasn't supposed to be like this.

Andrew Lansley wanted KPMG Global Head Of Health Mark Britnell to be CE of the NHS Commissioning Board; but the Treasury over-ruled that, and imposed 'Making Your Numbers' Nicholson.

The rest is, like Andrew Lansley's political career, history.

So it is like this - the NHS is now and will be the Nicholson Health Service, with nice-and-easy-to-grip clustered PCTs giving Comrade Sir David a 2/3 management discount on decision-influencing, and HSJ reporting a long-likely and already-partially-granted temporary reprieve for the intermediate tier of strategic health authorities will be extended, due to the cryogenic progress of the Bill.

It was as surprising as gravity when HSJ today reported that clustered PCTs will have ruthless Taylorised standardisation imposed on them by the DH.

Comrade Sir David is not fond of publicity for its own sake: it is not his way. But he has worn health select committee chair Stephen Dorrell's logo of 'The Nicholson Challenge' as the byline for the current four successive financial years of £4 billion annual efficiency gains with apparent insouciance.

Nicholson offers a 'strong figure' style of management. The need for the values that the NHS has at its best represented - ones in which he clearly believes - may never have been greater. Those values are beautifully expressed in the language of the legally-toothless NHS Constitution: Nicholson comes alive to a touching extent when he reads from it.

Let us hope that will be enough to see things through.