Editorial Thursday 11 October 2012: Do Comrade Sir David's contradictions look big in this?
I was amused by former Labour clinical adviser Dr David Kerr's piece in today's Guardian about why he agreed to become the Conservatives' clinical policy adviser, but fell out of love with Andrew Lansley's top-down redisorganisation.
(Kerr should advise the Lib Dems next, just to get the full set.)
In his piece, Kerr described the reforms as 'Heath Robinson'.
Which is a nice line.
It's also phrase that I used back in February 2011, in a piece called 'Stalin meets Heath Robinson'. It's fine: if you see a good line, why not nick it? I do it all the time.
Click here for details of 'Lansleyshambles - game over, as Jeremy ‘Bellflnger’ Hunt does the reconfiguration hokey-cokey', the new issue of subscription-based Health Policy Intelligence.
That February 2011 editorial was a fun little piece about price competition U-turns, private sector involvement U-turns - all good stuff.
And it linked to a contemporary interview by HSJ editor Alastair McLellan with Comrade Sir David, which really repays re-reading.
The Comrade In Chief told Alastair, "you can have 250 consortia if they work together, if they pool resources and if they decide to buy rather than make their commission support. If you [have] got 100 consortia dealing with a great big teaching hospital [they] need commissioning support that will give [them] the muscle. Don’t create 20 different commissioning support organisations - create one big one".
He also said that the NHSCB would not have “fiefdoms that have different ways of working”.
Best of all, Comrade Sir David told HSJ's readers that 'it would be “a problem” if too many CCG accountable officers were general managers; this would mean the spirit of the reforms had not been properly “embraced. There is a danger that the system reverts back to the past. I’m often accused of doing that ... genuinely not what I’m trying to do".
That was February 2011.
HSJ today published research indicating that 22% of CCG accountable officers are GPs. In March 2012, that figure had been 38%.
The HSJ data finds that "72 per cent of groups have chosen a manager as their accountable officer - nearly all of whom are currently senior primary care trust managers. A further 6 per cent have picked managers who also have a nursing or midwifery background, or public health directors. Many more CCGs - 89 per cent - have GPs as their chairs. The remaining 11 per cent have lay chairs".
So has Comrade Sir David failed, as "the system reverts back to the past"?
Or are we far more centralised than ever before?
Twenty months is a long time in politics.
Do Comrade Sir David's contradictions look big in this?