Annex B: Frequently Asked Questions on the Health and Social Care Bill

Services subject to tariff will continue to compete on quality: there is no question of introducing price competition.

Crikey. No sooner do I write a piece on competition, then NHS Supreme Soviet Chairman Comrade Sir David Nicholson writes to the whole NHS setting out a U-turn on competition.

(Well done to Health Service Journal for spotting it so quickly.)

It was possibly the least surprising U-turn in history. Possibly the UK's prominent academic supporter of competition in healthcare Zack Cooper warned that price competition would be "a hugely retrograde step".

We examined various absurdities in the proposal just before last Christmas, as regular readers may recall.

A more equivocal picture was painted recently, when Comrade Nicholson told Parliament's Public Accounts Committee that "you’ve got to be able to measure what you mean by quality. So you’ve got to have real clarity about the quality standards you want to deliver. You need to monitor them and then you need to have patients who are sufficiently educated and informed to be able to help you do that. We have yet to come across any services that have done that, but it seems to us that to leave that open would be sensible way of taking things forward".

The not shy, top-down all-supervising NHS Commissioning Board
Goodness me.

I did point out before Christmas that it was slightly under-recognised that the NHS Commissioning Board "will be very much the new performance-managing centre".

It's pretty clear now, thanks to Nicholson's 'Dear Comrades' letter.

His epistle to the apostles warns, "The Board will be confident about leading change at scale – not through top down diktat, but neither being shy about claiming a leadership role".

And Nicholson offers a hearty hint that clustered PCTs will become the regional infrastructure of the NHS Commissioning Board, with the phrases "The rapid emergence of pathfinder consortia is an important reason for consolidating PCTs into cluster arrangements: the development of clusters will create space for pathfinders to take on delegated responsibilities earlier where they are ready.

"We have chosen to create a national timeline and framework for the formation of clusters, although the process will be driven locally. This national consistency is important in order to keep a tight grip on finance, performance and quality during the transition, and because the end-point will be a single organisation covering the whole country and supporting a vibrant system of local consortia: the NHS Commissioning Board. That is very different from the current system of separate statutory organisations, and we therefore need to develop a more consistent and uniform approach during the transition".

Sir David was not joking when he talked about his "tight Stalinist controls".

Was he?