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Editorial Wednesday 8 August 2012: Health Policy Intelligence 49: The red ties that bind Comrade Sir David

Below is the first few paragraphs of the latest issue of our subscription-based publication Health Policy Intelligence.

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The red ties that bind Comrade Sir David

Amid the NHS’s ongoing good performance on its main waiting time targets, analysed by the unmissable GooRoo here), it is at times easy to forget just how many staggering moments healthpolicyland has witnessed in shock and awe over recent years.

We have heard special, special Health Minister Simon Burns’ battle-cries of “NYE BEVAN!”. We have seen Our Saviour And Liberator Andrew Lansley repeatedly chewing his glasses in the House of Commons. We have, in our imaginations, stroked NHSCB Chairman Mal’s Tom Selleck tribute moustache.


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.


Yet all of these pale into watery insignificance beside the sight that greeted viewers of the latest board meeting of the Nicholson Commissioning Board Authority. Dear reader, if you did not see it and you are not sitting down already, our health and safety consultants recommend that you do so before you read the next line.

Comrade Sir David wore a tie.

Yes, really! The infamously ‘No Neckware Thanks, I’m A Trotskyist’ Leader of the Free(ish) NHS appeared sported a tie, just moments after I had tweeted about the possibility of him donning a red cravat for the meeting.

You don’t need to ask me what colour it was, do you?

On hearing of a Turkish ambassador’s death, the famous French diplomat Talleyrand reportedly mused, “I wonder what he meant by that?”. Comrade Sir David’s sartorial signal has provoked similarly intense Kremlinology among health policy adherents. Ties are a powerful unifying signal, of course: emblems of belonging. Nicholsonian grip appears to be extending its already-mighty reach to the Windsor Knot.

Indeed, tie-wearing is also quite antithetical to the bottom-up spirit of liberation. A tie is top-down, in physical form. Note also how the arrow points down suggestively to the groin. On this reading, the Comrade In Chief’s sartorial message to incautious aspiring liberators is quite unsuitable for a family publication such as Health Policy Intelligence.

Oh, and there was also some business conducted in the Board board meeting as well. Chairman Mal was on good form, re-emphasising that the NHSCB’s 27 Local Area Teams' relationship with CCGs will be very much one of partnership. This is lovely LATeral thinking, but the notion of partnership between the part of the NHSCB that gets all the money to distribute and reports to Parliament and its local presences could be stretching the definition of the word a bit far. Oh, and don’t think about mentioning that 27 Local Area Teams sounds a lot like the 28 strategic health authorities pre-2006.

The relationship between Local Area Teams and commissioning support services also remains unclear. You will recall the original intention that CCGs were to be very much the customers of commissioning support services. You remember: choice and all that liberated, sovereign stuff.

The ‘Steering Or Rowing?’ write-up of the recent simulation event lets the cat out of the bag, when saying, “whilst CCGs and CSSs collaborated within and across their own organisational groups, they tended to collaborate less frequently with each other. Issues about customer / supplier relationships appeared to underline this approach”. In a fascinating linguistic development, HSJ journalist David Williams tweets that commissioning support services are now to be known as commissioning support units. As you already know, language like this matters.

It matters even more given the recent revelation in HSJ that the NHSCB, which hosts (i.e. owns and is financially responsible for) CSSs / CSUs until December 2016, is going to commission them to provide it with support services. Fans of postmodernism will applaud the panache with which the NHSCB plans to commission itself to support itself. Comrade Sir David’s enthusiasm for market-style disruptive innovation appears to be as strong as ever.

This is the end of the extract from the latest issue of Health Policy Intelligence. Subscription is £69 for 12 months, and funds the existence of this site. For details of how to subcribe, email editorial@healthpolicyinsight.com