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Editor’s blog Monday 5 July 2010: Not the White Paper (and maybe not next Monday either)

The Magnificent Timmins does it again.

Nick's FT piece confirms what we reported in our coverage of David Nicholson's Confed speech: that Lansley's proposed NHS reforms are held up by the Coalition committee as well as by the Treasury.

According to Nick, the Coalition committee has "rejected" the draft of the White Paper, which was due to go to Cabinet this week for launch next Monday.

Nick also cites DH sources saying there were no "deal-breakers" in the committee's concerns. One wonders if these were the same sources who tried to spin Andy Burnham's preferred provider U-turn as not a big deal.

It's all good gossip. Does it matter?

Well, yes, it does. First of all, the people wearing big smiles at the Confed conference in Liverpool were the recruitment consultants. Change with a new government is not exactly unfamiliar to NHS managers. It was therefore surprising to talk to so many people in Liverpool who were so demotivated by the uncertainty over the future of their careers that they saw a more likely future removing their skills and experience from the system, and selling them back in as consultants.

Which is fine for them, if the mortgage is pretty much paid off and you have the pension accrued. Bit of a win-win.

Less fine for a system which is going to be reinventing itself along unclear lines, and now potentially without this huge amount of experience and folk memory of where the bodies are buried.

It also matters because the Conservative policy proposal shaping the current plans, Autonomy And Accountability was published in 2007. That is three years ago.

It is a matter for significant concern that in three years, they have failed to come up with an implementation plan that would make it over the first hurdle.

It's not an easy thing to shift the commissioning role (currently done badly by PCTs) to new organisations led by GPs (or which will channel GPs' will). Getting the incentives right won't be straightforward. There is a big conflict of interest between the commissioning and provision function to manage.

All of that is fine. What is not fine is the apparent lack of thought about financial governance arrangements, given the currently low level of commissioning excellence. There are places you could let go on and do it - BEN, Tower Hamlets - but not lots of them.

It is therefore obvious that you are not going to let everybody just go commission, without passing some sort of test.

Unless we want the Wild West. At Confed, I suggested to quite a few senior and experienced people that under what is currently known, we are heading for the Wild West in commissioning - a free-for-all, let-the-market-rip, shoot-from-the-hip terrain, long on liberty and short on sheriffs. Nobody disagreed with that suggestion. Nor did them think it was a good way to go.