Simon Stevens has arrived.  You won't have noticed.  The new boss of the Carbuncle is a man who can walk and leave no footprint.  He can stand in the midday sun and cast no shadow.  Some say, he has no finger prints...

Already, under his influence, the Carbuncle's HR director, Jo-Anne Wass, and policy director, Bill McCarthy, have called for a taxi.  I expect Babs Hakin and Jane Cummings to be next.

Stevens is shaping his team.  A team that will take control and create some policies that mean something.  Provide leadership.  Already he has appointed, from the senior ranks of the DH, Karen Wheeler, as his director for transformation and corporate operations. She will oversee functions such as IT, human resources, and internal operations.  A mirror of the job she did at the DH.  I doubt they will recruit a replacement.

This appointment signals an end to the war between the DH and Carbuncle and the beginnings of blurred boundaries.  Hunt hated the Big Best but needed him and the feeling was mutual.  Stevens is urbane, polished and smooth.  He will exploit the ambiguities in the clunky Health and Social Care Act and quietly subsume functions from the DH.  His background includes a stint at Number 10.  LaLite will be of little interest to him.  He is used to reporting to Prime Ministers.

Stevens knows he has taken on a non-job.  The boss of the Carbuncle is just one part of a deathly trinity; Flat-Earthers, Off-Sick and the Carbuncle.  A deliberate attempt to distribute leadership and power across one of the world's largest remaining nationalised industries.  The rearrangement cost a fortune and doesn't work; we all know that.

I doubt Stevens, a man with a cultivated, international management background, will have much truck with Flat-Earth inspection and will regard Off-Sick as an ornament. He is a Balliol scholar and former Labour Councillor and was plucked from obscurity by old-Labour's Frank Dobson but it was with Alan Milburn that he flourished.  He wrote The NHS Plan, introducing PCGs and later PCTs, then moved to become Tony Blair's Health-SpAd.

Later he ran a chunk of US healthcare giant United Health, travelling the world, accumulating enough Air-Miles for a trip to Jupiter and enough knowledge to know markets in healthcare don't work.

Everyone fears Stevens will sell the NHS to Marks and Sparks.  He can't and he won't.  The mood music I hear from Number 10 is no different to what he will hear.  Lansley's reforms have been a disaster; they have to be fixed by 2015 and competition isn't going to help.  The only issue is money.

Never was political concern about the money better illustrated than in LaLite's refusal to accept the Pay Review Body's recommendation; a 1%  increase.  It amounts to just 0.18% of the NHS budget but Ministers would rather have a battle with the unions and risk public disapprobation, than pay the 'doctors and nurses who work so hard at the front line'.  Wage inflation, however small, is not affordable and anyway, the real plan is to dismantle national pay-bargaining.  No new legislation is required for FTs or Trusts to determine pay locally, they just need a push.

This is a big step that would suit Stevens.  He knows his only lever is commissioning and commissioning his only chance to change the NHS.  Tighter, better commissioning focussed on quality, quantity, price, delivery and service.  Commissioning that could go as far as specifying the grades and numbers of staff that deliver services and even their pay; perhaps agreeing a bonus for delivering on-time, on target with public satisfaction a key determinant.

Stevens knows the big stores are successful because they buy the right stuff, at the right price and put it in the right place.  Buying-Better-Healthcare-Better will be his mantra.

Stevens will have learned from his travels; top-down doesn't work.  If CCGs want to merge with Social Services, or practices federate and vertically integrate with the local FT, I expect Stevens will find a pathway for them.  Expect commissioning to be the tool to encourage FTs to sponsor and take on marooned Trusts.  Neighbourhood will be the new National.

Big task, big job, big risk but do you know what?  He'll make it look easy.

Have a good weekend.