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Editorial Friday 12 September 2014: Well done, Monitor

Well done, Monitor: nice work.

Yes, you read that right. I typed it out loud, in the real world. I even meant it. Open code bracket; forward-slash irony, close code bracket.

Monitor have done a smart, sensible thing, which is to leave its central function of independent economic regulation to one side temporarily, and retrain as a midwife; more specifically, in intervening in the attempted rebirth of Tameside and Glossop NHS Foundation Trust as the UK's first accountable care organisation.

This is experimentation, of a kind upon which the NHS Messiah Simon Stevens will smile benevolently. And it's important to remember that it may not work.

What is important is that a relatively small provider trust which isn't viable economically or quality-wise as it stands in an NHS after these unprecedented four successive financial years of flat cash is trying - with help from its (newly-shorter-armed) regulator - to do something new and different.

Genuine innovation, in other words. And one of the ways in which you can recognise genuine innovation is that it includes failure.

Now, to wish for failure in healthcare provision seems perverse for a reason: it is perverse. Yet risk-aversion about attempting different provision forms will condemn the NHS to a provider-side status quo which means either ever-deepening deficits, deteriorating quality or waiting lists starting to stretch back out to the horizon.

I have literally no idea whether Tameside and Glossop can do this. I doubt that they do, or Monitor. I'm willing to risk a small wager that not even Simon Stevens knows.

That is not the point. This is an experiment - and no doubt, there will be particular watchfulness about quality and safety. Given the potential role that the ACO model might play in some of our health economies, it might be unacceptable for the pioneer site to fail on quality and safety grounds.

That's OK ... but we also have to hope that the supervision will be permissive and proportionately risk-averse. A good midwife and an overbearing nanny are two very different things, which will probably lead to two very different outcomes.

For now, let's wish Tameside and Glossop well - and say a perhaps-unfamiliar phrase once again: well done, Monitor.