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Editorial Friday 11 May 2011: From perestrokia to glasnost? The NCB and the possibility of change

Many journalists and commentators are cynical, or become so. It can become dull as a default position.

I've seen a couple of things today which indicate that there may be a possibility that the NHS Commissioning Board may recognise the sound of a penny dropping when it hears it.


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Health Policy Insight has been at the forefront of people suggesting that the NCB might all-too-easily become the new DH - a centraliser of authority and a locus of control.

Quite frankly, the risk that this will happen remains pretty high.

But two things I saw today have rather made me think there is at least a possibility that the NCB will be some kind of force against command-and-control-and-how-many-tractors-have-you-produced-today-Comrade?-ry.

The first is this entertaining blog by NAPC past chair and adviser on the reforms Johnny Marshall, entitled 'The Kremlin', which sits on the NCB's own website.

It is not possible to imagine a pre-liberation post on the DH website being thus titled, nor for the sly reference to "the grip of QIPP" to have gotten past the baleful Gateway process. (I remember with some astonishment that a couple of jokes slipped past Team Gateway in a document I re-edited for DH some years back: the sense of minor triumph was considerable.)

Johnny also alludes to the penny dropping about duplication if not ce ntralisation on the part of the board, and the second of the two signs today is significant: HSJbreaks the story that the national communications function is not to go ahead. Checkpoint Two appears to have spotted that the NatComServ's travel papers were completely out of date.

Well done, the Border Agency staff of Checkpoint Two. We pointed out quite frequently that a centralised comms function for CCGs was set to infantilise them at birth.

Communications: a local CCG must-do
The concept of a 'nat-comms' function was a silly one at many levels. In an era of faith in markets and contestability, the lack of an open tender process was dim-witted (and possibly illegal).

Likewise, given the frankly mixed quality of communications extant in the NHS hierarchy, the possibility of the NHS losing scarce skills (which is a reality among those with experience of commissioning) was not a tenable argument.

More to the point, if CCGs are to succeed, then they unarguably, unambiguously must own the communications function themselves. This is about local clinicians taking power and responsibility alike. That means explaining your changes and answering for your touch choices. That is communications.

These are two good signs. They give a warm glow, although it's not going to melt the permafrost of a long Cold War yet (no idea why Soviet imagery keeps crossing my mind). But the current perestrokia seems to stand some chance of leading to glasnost.

And if it does, then that will be a good thing.