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Editorial Monday 13 August 2012: Comrade Sir David pulls a Smokey

I didn't really have the Comrade In Chief down as a soul man, but NHS reform throws all sorts of surprises at us.


Click here for details of The red ties that bind Comrade Sir David: postmodern NHSCB to commission itself (oh yeah, and what cowboy drafted this mandate?), the new issue of subscription-based Health Policy Intelligence.


His letter to NHS leaders about transition from now till Friday 29th March 2013 (which will be Good Friday, biblically enough) has a perfect echo of the opening line of what is probably Smokey Robinson's greatest song, 'You Really Got A Hold On Me'.

The lyric in question is "I don't like you but I love you".

Comrade Sir David tells the faithful that as of 1 October 2012, "NHS Commissioning Board and NHS Trust Development Authority regional directors should take on management responsibility for the teams managing both 2012/13 operational delivery and planning for 2013/14.

"For the NHS CB, people appointed to future regional and local leadership roles in the NHS CB should take on management responsibility for the teams managing both 2012/13 operational delivery and planning for 2013/14.

"For the NHS TDA, people appointed to future Delivery and Development Director roles in the NHS TDA should take on management responsibility for both 2012/13 operational delivery and planning for 2013/14, in respect to the FT Pipeline and provision system.

"NHS CB and NHS TDA leaders working in this way will be accountable to their new organisations for future planning and development and be accountable to PCTs/SHAs for relevant delivery and performance in the current system for 2012/13".

This means that PCTs and SHAs are officially corpses as of the date of reading.

Don't you love a bit of non-top-down decentralisation? I know I do.

Caveat (emptor)
Of course, the letter also says "Until April 2013, SHAs and PCTs retain their statutory functions and governance arrangements. New bodies will only be accountable for responsibilities consistent with their preparatory powers and planning for 2013/14".

Of course.

The Comrade In Chief cannot re-write the 2012 Health And Social Care Act. With powers like these, he doesn't need to, does he?

The 'I don't like you but I love you' bit comes in the bathetic final paragraph: "Introducing new system leaders to work alongside current SHA and PCT leaders has a particular impact on these individuals, but designing transition arrangements in this way does not mean that they have no further role to play. On the contrary, their skills, experience and dedication to the staff they lead will be even more important as they support new system leaders in managing a smooth transition. To succeed we will need strong and effective partnerships, with new and current leaders working together to achieve the secure and supported transition we are all committed to delivering".

Less poetically, it's like a couple of drunks in a gutter who've just been brawling, telling each other "you're my best mate, you are".


And if you believe that, I've got some real estate in Florida that I can sell you very cheaply.

Top-down NHS centralism is dead. Long live top-down NHS centralism.