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Editorial Monday 17 October 2011: Questions for Professor Grant, NHS Commissioning Board chair-elect

At half-past-ten tomorrow, Professor Malcolm Grant, chair-elect of the NHS Commissioning Board will be interviewed in a confirmation hearing by the Commons health select committee (you'll be able to watch it here).


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The chair job is a big one, which makes it pretty curious that it is so part-time, at two days a week. We cannot of course know whether it was conceived of as part-time before Professor Grant was sounded out regarding applying for the role.

These are some questions the health select committee might usefully ask him.

1. What is the single most important tool that you, as chair-elect, would have to hold the chief executive of the Board to account?

2. The Board will have enormous power in the new NHS, co-designing the payment tariff with financial and provider performance regulator Monitor; giving or removing from clinical commissioning groups the power to commission; commissioning on behalf of CCGs it deems unready. This suggests high risk of centralisation of power in the Board. What checks and balances are in place to effectively prevent this?

3. Given the policy intention to delayer and reduce management while moving away from central top-down performance management, why does the Board need regional arms?

4. Given the Board's power, can its executive be effectively held to account by a part-time chairman?

5. Did you haver any conversations about this role with the Secretary Of State or any other Government ministers or special advisers prior to applying for the job?

6. In your role at UCL, you have been clear about your view that elite academic institutions should be appropriately funded to maintain excellence; if necessary, at the view of lesser ones. Should this also apply in the NHS?

7. Would you be concerned if the proposed failure regime allowed NHS providers to apply to financial regulator Monitor for a higher-than-tariff payment for services without the consent of their commissioner? If so, then what should happen? If not, why not?

8. CCGs who decide they no longer wish to commission services from local providers on quality and safety grounds risk local unpopularity among career-threatened provider clinicians, local people, local media and local politicians on Health and Wellbeing Boards. How far can and should the Board go to support CCGs in such circumstances?

9. The NHS's traditional approach to failure has involved a combination of pretending it is not happening; persecuting whistleblowers; and hidden subsidies. Clinical commissioning will, if it is real, have failures. How will the Board strike a balance between protecting the public interest and allowing CCGs the liberty to learn by doing, which must involve learning from mistakes?

10. Who should decide on what is the appropriate size for a CCG to be viable?