The cultural logic is appropriate that in an NHS broadly run along Soviet (if not Stalinist) lines of centralised command-and control, you would have czars somewhere in the mix as a nod to the imperial past.

The Department of Health has a plethora of czars in its crown. Prominent among them is its cancer czar Professor Mike Richards, who was given the hospital pass of doing a report to justify increased spending on expensive cancer drugs. Which he did.

Professor Mike Richards: "if you wanted to sufficiently change outcomes from cancer I would not spend £200 million on expensive cancer drugs; I would spend it on earlier diagnosis and involving GPs".

The Conservative Party's promise of a £200 million national cancer drugs fund fired the starting gun on the electoral auction of promises; in the process flagrantly undermining NICE.

Earl Howe's spectacular candour about NICE becoming "rather redundant" raised the stakes further. And did so, as we exclusively revealed on Wednesday, without consulting or warning NICE itself.

Delegates report that speaking in a session at a recent ABPI event, Professor Richards was asked about his personal views on the national cancer drugs fund. Richards told the audience, "if you wanted to sufficiently change outcomes from cancer I would not spend £200 million on expensive cancer drugs; I would spend it on earlier diagnosis and involving GPs".

He is clearly right on this one.

Other obvious criticisms of the national cancer drugs fund are its regional basis by SHA, which contradicts both the extant logic of one national decision for one national health service and the future logic of localised plurality.

Extraordinarily, the DH NCDF consultation also suggests that each SHA should "take the lead in considering the evidence on drugs for different cancers, to minimise variation, reduce duplication and make the best use of scarce expertise".

Eh?

That is simply viring the current central rationing decision-making by NICE out to each SHA for one or two areas.

Perhaps I am being sweetly naive to expect any logic here.