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Editor's blog 19 June 2008: More from Confed conrence: is David Nicholson still gunning for Monitor?

Is David Nicholson still gunning for Monitor?

No matter how bad your day is, Joe Simpson has had a worse one. The climber and inadvertent bestselling author gave a thoroughly moving and harrowing speech today to Confed. His recounting of the physical ordeal was harrowing just to hear.

Simpson niftily avoided the potential pitfalls of emotionalism, drawing instead a deeply touching and personal message that feeling totally alone and beyond contact or human touch is the worst kind of pain.

After that speech, David Nicholson wisely refrained from performing with his usual bullish barnstorming style. In content terms, it was of a piece with Alan Johnson’s and as stated in the first conference report, this is not necessarily a bad thing.

What Nicholson did, re-emphasising it twice, was to have a specific go at the relationship between foundation trusts and their regulator. Once might be a moment of pique, but three times is a definite message. Nicholson said, “the system has not been designed so FTs can spend more time and activity in managing their regulator than in dealing with their commissioners”.

A spokesperson for Monitor emphasised their view that the criticism was of the relationship between FTs and their commissioners, and commented “looking more to commissioners and communities is a behaviour we would want to encourage in FTs.”

Commenting on David Nicholson's speech to the NHS Confederation conference, Sue Slipman, director of the FTN said, "an effective relationship with the commissioners of services is of central and growing importance to foundation trusts. Foundation trusts also believe that having a strong independent regulator is an important condition of their own operational independence. However, in forging these relationships with both commissioners and the regulator, what foundation trusts do not want to face is double jeopardy.”

Is this a go at Monitor?
Nicholson has form with Monitor. It became apparent after the launch of the totally unnecessary £50 million deep clean programme for hospitals that he could neither force FTs to do the deep clean, nor to employ infection control matrons.

Relationships between the DH and Monitor have also been strained over the issue of unspent FT surpluses – although Monitor has made it clear repeatedly that the money is not providing much healthcare while stacked in banks earning interest.

'There is an intrinsic philosophical tension between Nicholson telling the NHS to be a bit more local and look out not up to Whitehall while at the same time arbitrating on the correct degree of time to be spent with regulators and commissioners'

This is odd, because a major theme of Nicholson’s speech was localism. There is an intrinsic philosophical tension between Nicholson telling the NHS to be a bit more local and look out not up to Whitehall while at the same time arbitrating on the correct degree of time to be spent with regulators and commissioners. I know we live in a surveillance society, but surely David Nicholson doesn’t have a camera in every senior executive’s office to do a ‘time and motion’ study.

Tom Smith will examine this theme in Health Policy Today at 5 pm


Sometimes you have to look very carefully indeed at language. Like the apparently official DH ban on the word “polyclinic” – have you noticed that in anyone’s speech?

Health Secretary Alan Johnson’s speech yesterday contained an interesting form of words, which was partly echoed in today’s keynote by NHS chief executive David Nicholson. And maybe it was just a verbal slip by Johnson, or a mannerism of reading the autocue. So this might be not much, or it might be really significant in some SHAs.

The phrase was “top-down reorganisation”, and it again cropped up in David Nicholson’s keynote. But Johnson’s use of “unnecessary top-down reorganisation” was the one that stuck a note.

There is a world of wriggle room in that phrase. Areas like London, which are significantly over-provided with hospitals, will have noted that with keen interest.

Health Secretary’s speech

He tells a good, if slightly worn joke, does Alan Johnson, and he comes across well. But it was a surprise to many delegates that his speech revealed only hints about the Darzi Review. However, there was a game attempt to justify the reform process under New Labour.

Johnson told delegates, “all the structural reforms of the last eleven years have been difficult but necessary”: historical revisionism that suggests a smooth linear narrative unconnected with the environment many managers have been living through. He also added “every structural reform has been the prelude to the Next Stages review”. Ahem.

GP fundholding was abolished just as evidence was being complied that it worked. Provider issues were addressed long before commissioners. 300 PCTs were set up and then abolished a few years later. As Brian Edwards said of Simon Stevens in the outstanding NHS 60 Review session “too many good ideas all at the same time”.

Alan Johnson’s speech had little that you couldn’t have expected yourself, with much on NHS 60 and lists of the service’s very real and many achievements, but there was a telling moment in the response to former NHS Confederation chair Peter Mount’s question about regulation – you know, the one Dame Gill Morgan always used to ask.

Told that over 70 separate bodies are able to inspect NHS organiations. Johnson told the conference “we ought to boil down the number of inspections”. There could be some good news coming out of that. Watch this space.