It looks like the Commons Public Accounts Committee has been giving Sir David Nicholson, Chief Exec of the soon-to-be NHS National Commissioning Board, a bit of a roasting.
The question was simple enough. If we are going to all the upheaval of abolishing the ten English region Strategic Health Authorities (SHAs) in April 2012, would that all be rather silly if Nicholson's NHS Commissioning Board was to then decide it needed a network of regional offices to do a great big part of managing the system?
Well, you'd think it was a simple question, but Sir David could well have been mistaken for Sir Humphrey when repeatedly pressed to give a straight answer.
You couldn't make it up
Sir David Nicholson: The Commissioning Board is one organisation.
Q103 Chair: But will it have regional arms?
Sir David Nicholson: Well it will have management tiers in it.
Q104 Chair: So will it have regional arms?
Sir David Nicholson: Well there will be management tiers. You could call them regions or not, but there will not be me here and all of the consortia there; there will be something in the middle.
Ian Swales: Location. That means location. The question was: will the Commissioning Board have a regional structure?
Sir David Nicholson: Well we have not worked all of this out yet, but if you think about the responsibilities of the Commissioning Board, on the one hand it is going to commission itself big, important national services, so the kinds of services that only need to be commissioned once, and there may be only one or two or three sites in the country. But it is also going to commission directly primary care; it is going to commission the 8,500 GP practices. So it will need both a national and a much more local representation in order to deliver that.
Q105 Chair: So you will have a commissioning body and you will have regional arms. You will have to.
Sir David Nicholson: Well at the moment, we have set out we are going to have 50 clusters.
Q106 Chair: 50 clusters to the commissioning body?
Sir David Nicholson: Yes. Those clusters, which are currently clusters of GPs, will be accountable to the Commissioning Board on 1 April 2012, so you will have, in a sense, 50 of those in the environment we are going into.
Q107 Chair: I am sorry to pursue, but maybe we will get this clear. In your answer to Stephen, you said there is going to be really rigorous monitoring to ensure that we keep down management costs.
Sir David Nicholson: Yes.
Chair: Great. There is a little bit of, "Is this local; is this national?" but great. But on the other hand, you will then need a machinery of governance to ensure that accountability. All I am trying to get out of you is: is that machinery of governance going to be a regional or a local thing? Are you going to have 150 of these at local authority level or are you going to have a regional structure? You, Sir David, as boss of this new commissioning whatever it is.
Sir David Nicholson: We have to work all this out. We are only just working out how much money is available.
Q108 Chair: If I can then take it to its next point, it is not going to be that different from the SHAs, is it?
Sir David Nicholson: Well the SHAs do providerside stuff, they do work force and they do commissioning; they do the whole system.
Q109 Chair: They may do slightly different things but it will be the same structure.
Sir David Nicholson: That is a big difference. That is a significant difference. We have not worked out yet how we are going to organise the Commissioning Board. Do not forget we have got until 1 April 2012. What I am doing at the moment is trying to put transitional elements in place in order to manage the arrangements as we take it forward.
Q110 Stephen Barclay: Can I just then tie in with that, because you said, "We haven’t quite worked it out," and when there is big organisational change, often that is when consultancy spend or interim spend goes up. We know from the Cabinet Office they want to have a tighter grip on that. We had a hearing on consultancy spend and, interestingly, the Department of Health is one of the two biggest spenders within Whitehall on consultancy; that is after your consultancy spend went down by 45% from 2006. So what are you foreseeing budgetwise in terms of your consultancy spend and your interim spend over the next two years? Are you seeing that going up at the same time as you are delivering the Nicholson challenge?
Sir David Nicholson: It will go down.
Q111 Stephen Barclay: It will be going down, will it? Even while you are delivering this major change programme?
Sir David Nicholson: Yes