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Editor's blog Tuesday 7 July 2009: Simon Stevens on commissioning; and the combustibility of quangos

Hello. Today we have a new interview with Simon Stevens, conducted at the recent NHS Confederation conference in Liverpool.

The noisier debate about NHS reform over recent years focused more on the practical effects of Stevens' thinking about the introduction of choice and contestability into the NHS.

The other 'c' word (no, not Paul Dacre's one) - commissioning - was every bit as critical to the prospect of achieving meaningful change, but unfortunately, the major efforts in the early years of this decade were focussed on the provision side of the system and on capacity issues. The political war on waiting lists was busy being won.

Stevens discusses the roles of commissioning and contestability as the NHS approaches an economic crunch, and offers his own definition of the three qualities needed for truly world-class commissioning.

Flammable quangos?
Elsewhere, various commentators have discoursed on opposition leader David Cameron's speech to Reform last night on the 'bonfire of the quangos'. Except it wasn't a proposed 'bonfire': that was just what the invitations said.

One of the best pieces is by Steve Richards in The Independent. It points out that Cameron has come up with an elegant analysis of the accountability deficit that quangos can induce, but also notes that they have policy commitments to create more, including the office of budgetary responsibility (Andrew Neil was also good on this on yesterday's Daily Politics.  Ann Treneman's sketch in The Times is also sceptical of the promises. Michael White's Guardian piece also has a clear-eyed view of what quangos do and why governments turn to them.

Quangos have been a political get-out-of-jail-free card, as Richards notes, deepening the democratic deficit. He also cites approvingly the recent IPPR suggestion that senior civil servants should become more accountable for the delivery of policy.

Quangos are an easy target when looking to save money, and none should be above review. In the NHS, many if not most of the quangos (NICE, CQC, NPSA, MHRA) have real functions, which must be done somewhere and by somebody.

There is of course also an interesting irony in this debate, since the Conservative proposals or an independent board to run the NHS will create the biggest quango of all.