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Editor's blog Thursday 28 October 2010: A short list for the national commissioning board job - Britnell, Farrar and Selbie

There is a short list in relation to the new NHS independent National Commissioning Board (NCB) - the Coalition Government's enormous new "light and lean" quango.

It is a short list because it only has three names on it.

It is not, of course, a shortlist. You cannot shortlist for a job that has not been advertised: that would be legally and procedurally wrong. (The NHS never does such things, of course.)

More to the point, given that the NCB will exist initially in shadow form, there is a strong likelihood that the first boss of the organisation will be essentially an interim. The substantive appointment is relatively unlikely to be made until much closer to the actual 'hard' launch of the organisation.

Nonetheless, this short list exists. Health Policy Insight understands that the three candidates on this exploratory short list are KPMG global head of healthcare Mark Britnell; NHS North West chief executive Mike Farrar; and Brighton and Sussex University Hospitals chief executive Duncan Selbie.

(The source, leak-seekers, is not any of these three men - but does work within a stone's throw of Parliament and is a civil servant. I'm too computer-illiterate to hack - and on a good day, too principled.)

It's an intriguing shortlist. All three are credible candidates; all three would bring different emphases to the role.

Which, as we have noted before, is going to be very powerful: effectively, the NCB becomes the new Health Secretary; rivalled only in power by Super-Monitor (featuring the NHS Co-operation and Competition Panel on guest vocals) as the new DH. Its tasks will include deciding what the NHS must commission; organising specialist commissioning; performance management of GP commissioning consortia; holding the contracts of all primary care providers including GP practices, dentists and pharmacists.

Not much, then, for an organisation that Health Secretary Andrew Liberatin' Lansley wants to be "light and lean".

Before weighing the candidates, it is also worth saying that there are notable absentees who would be equally credible candidates. One obvious absentee is DH and NHS CE Sir David Nicholson. A vuvuzela of rumour about Sir David's happiness in post resonates constantly, but genuinely informed sources suggest that any initial teething issues with the new administration are broadly in the past tense. Other Whitehall sources are unclear whether the job is one Sir David actually wants. Perhaps his interest is 'taken as read'.

Another absentee is UnitedHealth maestro Simon Stevens, formerly of the ministerial and prime ministerial Parish of Special Advice. Paradoxically, Stevens' absence from this short list makes it look and feel slightly more credible. There would be questions of affordability in his candidacy.

Mark Britnell was the man appointed by NHS CE David Nicholson to "make commissioning sexy". Views vary as to the erotic capital that was ultimately invested in World-Class Commissioning, but few deny that Britnell could not have tried harder - or indeed learnt more from the various challenges (notably the FESC framework for procuring external support in commissioning). Lansley has been scathing about world-class commissioning, but how much of this was politics and how much judgment is opaque.

An MTS graduate (whose fellows in that intake speak highly of him), Britnell ran Birmingham's big teaching hospital before becoming the youngest-ever SHA chief executive. So provision and system management are covered, as well as his commissioning experience.

Britnell's current job took him from matters world-class to the global head of healthcare for accountancy and management consultancy KPMG. He has remained in demand as a forecaster. A highly-effective self-advocate with confidence to burn, the logic of his career progress to date may be hard to overlook.

Rather obviously, he already has a job. Global, no less, and secure as these things can be. There would be apparent affordability issues - the salary, capped at the PM's £150,000, will be about Britnell's current travel expenses with KPMG (and bonuses for public servants are so 2009, darling!). However, he might (rightly) figure that his value in the private sector would be undimmed - and indeed probably enhanced - by another spell of National (Health) Service.

Mike Farrar has consistently been one of the highest-performing NHS chief executives, while retaining the widespread respect of his peers. He was the first old-money SHA chief executive to have an all-foundation trust provider health economy. An engaging public speaker with a keen interest in the financial plumbing of the NHS, Farrar's relationship management in NHS North West has tended to see the region avoid major dramas (or at least, public awareness thereof).

He was widely known to have been a candidate for the NHS chief executive vacancy in 2007, to which incumbent David Nicholson pipped Ian Smith of BMI Healthcare (brother of Imperial CE Steven Smith). He is less well-known to have been in the final stages for the permanent secretary job at DH.

Farrar has given innovative commissioning its head, and won plaudits for introducing an sticking with the US Premier system. NHS North West also brounght in patient-reported outcome measures (PROMs) ahead of the rest of the NHS. Pre-Darzi, he was a regular advocate and practitioner of increasing clinical involvement in management decision-making. He is known for having made his numbers (targets) without bullying being the principal weapon.

His critics use the GP contract which Farrar negotiated as a stick with which to beat him; but in truth there has been much historical revisionism over the contract negotiations (not least by Laurence Buckman of the BMA) about how well they thought GPs would do. There was no baseline (or data ... or metrics) of GP performance: the new contract, however expensively, created one.

More to the point, like all SHA CEs he will be looking around for a job. Unlike many SHA CEs, Farrar's skill-set is suited to the demands of the Liberated New World.

Many may perceive Duncan Selbie to be the 'dark horse' candidate, which will suit the laconic and likeable Scot fine. He remains a DH employee, on secondment to his current acute trusts. Selbie's jobs in DH included system performance management in the Nigel Crisp era (he was the author of the famous autumn 2005 'Selbie letter' to CEs, informing them that "Sir Nigel will be taking a close and personal interest" in performance on financial control - a letter to no avaiil sans pareil.

But Sebie avoided the blame for the system crash in general and the letter in particular - and rightly so. Many were responsible for the drivers that led to that era's disastrous conclusion - he was not among them.

His next job probably explains his presence on the list: he was the commissioning supremo in the post-Crisp iteration under acting NHS CE (and big Health Policy Insight fan) Sir Ian Carruthers. Excellent reports have emerged from Selbie's turnaround of the traditionally-troubled Brighton trust - like Farrar, he gets and lives the importance of empowering clinicians. He has been at Brighton long enough now, and maintained performance: a job move would be logical.

Too much detail of the Liberated New World remains unavailable to give a clue which of the candidates is likely to be in pole position. More to the point, a Health Policy Insight endorsement could be an air-kiss of death to a decent candidate.

All three could do a job (as indeed could various absentees, of higher and lower profile or self-publicising mien).

Could they do the job?

Too early to tell.