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Anon 1 May 2:24

Sorry, but as someone that sits provider side and didn't have that many good words to say about commissioners in the PCT days I'm a long way from convinced that commissioning can get no worse. a lot of the work PCT's did wasn't great, but they were slowly getting better.

Judging by the procurement documentation and processes that I've participated in so far this year, that have been led by:

1 - The new local authority PH function in one case
2 - NHS England in another
3 -Two different CCG's in another two

it's already got worse. Half written service specfications, MOIs that contain almost no information, unrealistic procurement timetables, unrealistic fianncial envelopes.

Everything that was bad about PCT processes seems still to be there, it's just that there now seem to be a couple of seemingly disinterested GP's present at the bidder meeting and interview stages.

As for the financial savings. £0.5bn? The one-off costs of the reforms range from government estimates of £1.6bn to independent estimates of up to £3bn.

So between 3 and 6 years to pay off. Does anyone honestly think that CCG's will stay on the scale they are for anything like that long? Am I the only one that looks at them and thinks "I've seen you before but you had a different first initial last time around".

How does it go? DHA's were replaced by PCG's that became PCT's, that merged and grew until they were the same size as the DHA's they replaced, that have now been replaced by CCG's ... that.... Well you can see where I'm going with this.

Without a change of government.... I give it four years before we're back pretty much where we started.

Whilst governments of all stripes love to bang on about the awful growth in bureaucracy of the NHS, the fortunes spent on managers and administrators, and all pledge to sweep it away, none of them seem to question how and why it has grown up.

The simple facts are that if you run the system as a internal pseudo "market", that requires a bureaucracy to run it. If you think the Commissioner / Provider split is worth having and delivers quality and value, and all the major parties seem to believe that it does (although strangely no one seems too keen to undertake any kind of economic analysis to actually demonstrate the comparative benefits of spending money on this rather than directly on service provision), then that system requires resource.

Twice we've allowed commissioners to build the resource that they considered they needed to do the job effectively. Both times they've arrived at organisations of a roughly similar sizes, administering roughly similar areas.

We've done the "reform" and put in place a larger number of smaller organisations, with less resource before. What is it we think it going to be different this time?