15th March 2012 

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News and Comment from Roy Lilley

I watched the 'people's debate'. It went nowhere; oblivious of the people. It was a village hall performance. Clich�s, well-worn phrases, platitudes and corny lines aimed at getting a quote in MP's local newspaper.

For the most part Labour MPs were out of touch with amendments to the Bill and it seemed to me, the Tories had never read the thing in the first place.

LaLa sat next to 3rd Degree; slumped on the green benches looking crumpled and thoroughly fed-up. Their Bill in tatters. Competition watered down to a nonsense struggle around quality. We all know quality is only consistency with lip-stick. GPs are being forced into bigger and bigger groups that will put commissioning for anything more than a verruca out of their reach. The Secretary of State's duty is so convoluted I doubt even LaLa can explain it. It's really is not worth bothering with.

I doubt it would have survived had Dave not, rashly, backed it. I don't think you have to be MORI to predict the electoral disaster that awaits. There are 1.4m staff in the NHS. I reckon about 1.1m don't like what he's doing. If they all talk to their family, friends and the bloke in the chip-shop - there goes his majority. Add in disgruntled patients, the worried voluntary sector, hacked off PH people and HealthWatchers and he'll never see Westminster Bridge never mind the front door of Downing Street.

However, there is one beneficiary of all this; the Big-Beast, who has so cleverly positioned himself as both the saviour and destructor of the NHS. If he had not been so impetuous (or cunning) in the reduction of PCT personnel the CCGs would never have gained traction and LaLa would not have been able to claim the GPs were gagging for it.

More significantly; the idea was to push power out of Whitehall and into the hands of GPs. The Beast has turned it on its head and is busy sucking power back to the centre.

The Beast's masterpiece is the Commissioning Support Service organisations. They are not in the Bill, have no statutory authority or position. They are not a LaLa creation. They are a Big-Beast chimera.

There will be twenty, some say thirty of them, providing overarching back-office services. More important they will also provide the middle-office dealing with formulary, procurement, care-pathway-design, and very likely referral management services. They will exist to do what CCGs can't do, funded by the �25 per-head management cost allowance but, I predict, privately owned, will grow fat off the margin between cost and price.

The Beast has also cleverly taken advantage of an opportunity in the Bill that allows for NCB sub-committees. They will be morphed into 50 NCB local offices. He's made it clear he wants them run by ex-PCT cluster bosses but a significant number will take a commodious redundancy rather than be the Beast's performance manager.

The tentacles of the Beast are starting to reach into the CCGs. What started out as GPs doing their thing and deciding who should lead them has been marinated in a bureaucratic cauldron by Dame Babs. Bigging-up CCG chair jobs up as 'very, very senior' she told the (�-walled) HSJ's excellent news ferret Dave West, that chairs will be assessed for 'aptitude and attitude'. Oh how the GPs are going to love that! It's like voting for your MP and making him do a Myers Briggs assessment. Probably not a bad idea but I doubt the GPs will accept that level of interference even if it is part of the Beast's authorisation process.

CCGs will not even have a free hand over choosing their accountable officer and FD. They will come from a 'talent pool' of former PCT left-overs, helping the Beast to keep the redundancy Bill down.

The Beast, like God, has created an NHS in his own image with SHA's and PCTs. The wallpaper has changed but the room still has 4 walls and the view from his window looks the same.

Lala has lost the Bill, the plot and probably the will to live. It's all turned out much more Beastly than he could ever have imagined.  


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