Editorial Thursday 6 June 2013: Post-Comradeism - Asking The Wrong Question about who should replace Sir David Nicholson

Almost every conversation at the NHS Confederation conference in Liverpool opens with the phrase "So who's going to replace David Nicholson, then?"

This is a classic instance of Asking The Wrong Question.

Public policy sees a lot of Asking The Wrong Question, alas.

The Right Question is a very important place to start, though there is no guarantee of it leading neatly to The Right Answer.

In this instance, The Right Question (which we must fervently hope NHS England is asking itself) is "what kind of leader does NHS England and the health system require to follow Sir David Nicholson?"

There are five broad options to this.

Option One is The Comradetinuity Candidate. This option follows if the view prevails that so great and risky is the chaos of the semi-formed new system, beset by foreseeably flat cash, that no deviation for the True Comrade Path Of Grip (yes, I did just have a job lot of capital letters delivered).

Bill McCarthy could do this job. (I just got the most spectacular nose bleed on typing those words, which may be an omen.) Then again, so could Sir David Nicholson. Wouldn't that be fun?

Option Two is The Comradetinuity And Change Candidate. You do this if you think grip is still required, but some vision and sense of moving towards a new world, uplift and feeling that the person is 'one of us' among the workforce.

Sir Johnathan Michael could do this job. Then again, if you read the HSJ interview, so could Sir David Nicholson, apparently.

Option Three is The Free-For-All (Is Over) Let The Market Rip Candidate. This is not really feasible politically, nor sensible, but there will be those who think it's a good idea.

You would probably have to get someone from overseas to do this. Nick Seddon may have a few ideas.

Option Four is The Credible Clinician Who Focuses on Patients' Quality and Safety Candidate. I'm grateful to a reader on Twitter who pointed out the fact I'd omitted this. Which is quite poor of me, as this would be a good option. I don't feel it's likely, but it would be good. This requires political nous and probably splitting the role into a clinical job and a 'lead administrator job.

Sir Bruce Keogh could do this job, but would it be satisfying to him?

Option Five is the The Let A Thousand Dataflowers Bloom Candidate. This says that you take the reforms even further, driving radical decentralisation and autonomy, countered by national standards and tariff-setting, and monitored rigorously by Big Data. We don't have either the IT for this, or the money to buy it, but why compromise with reality.

Tim Kelsey probably thinks he could do this job.