The new NHS reform architecture contains within it a number of problems that have always been predictable. As I have suggested on many occasions previously this is in part a consequence of the very many different and opposing minds that have been shaping the reforms as they have been developed. The famous pause in April 2011 led to a considerable strengthening of the centre at the expense of CCGs in the localities. Since then the reforms have always been a combination of greater decentralisation, combined with greater centralisation. Once that process began relationships between the NCB and the CCGs were always going to be difficult.
But even before then there was an obvious problem built into this relationship – from the very beginning of the White Paper in July 2010. And this is straight from Andrew Lansley’s attic during that dangerous period when he was encouraged to think this up all by himself.
