Editor's blog Wednesday 2 February 2011: "Beyond Narnia" - an update from the front line

Earlier today, I was asked on Twitter (where I'm @HPIAndyCowper; do say hello if you tweet) to explain something pertaining to 'the Big Society'.

You've probably heard the Big Society joke, but just in case:

Q: What's the difference between the Big Society and the Big Issue?

A: Some people buy the Big Issue.

(Big Society czar Lord Wei has certainly heard it.)

I lumped it in a group with copper bracelets for rheumatism; Father Christmas; The Force from Star Wars; the Surrey Puma; and Narnia.

The last of that list proved topical, as a few minutes later, a regular HPI reader emails to say that the cluster document has taken NHSland "beyond Narnia. Employment solicitors will tear it to pieces. Our HR people regard it as bizarre that it ignores employment law in so many ways.

"So for many PCTs, it mean having a massive and pointless distraction of interviewing for one executive team; establishing bizarre governance arrangements; and kicking valuable NEDS and Chairs out of the door. Then ending up with a double layer of management - i.e. the cluster team and those managing in the PCTs.

"And what if one PCT Board approves what the new Cluster executive want to do and another does not approve? Unclear.

"It is, however, clear from our experience that shadow commissioning consortium GPs want local support; and not from, say, a sub-regional team somewhere.

"And re. the proposals to increase the power of Health Scutiny Committees? Not needed. I used to support one of these: we got attendance from all types of health providers ... NHS and private. Once you have to use the law to require attendance, you've lost the co-operation.

"And re. Health and Wellbeing Boards - have you seen their proposed powers?

"That's right - because there are none. They are there to 'encourage' co-operation. GP commissioning consortia can in effect ignore them. The public and patients have no way to influence in any significant way the consortia."

I couldn't have put it better myself. Any other readers' thought are, as ever, welcome - just email editorial AT healthpolicyinsight.com