In one of his last speeches as NHS England boss, Sir David Nicholson gave his final assessment of the reformed commissioning sector, a year post-transition.

Clinical commissioning groups were given a strong eight marks out of 10, and credited them for the fact that the system had not rapidly collapsed in the way everyone now admits they thought it might.

Poor old NHS England only got five Nicholson performance measurement points, as did commissioning support units.

The golden Nicholson raspberry went to clinical senates, sadly, whom he rated just four out of ten.

End Game cannot work out whether he was being quite charitable or utterly damning. After all, some clinical senates have not actually met yet, and several of those who have, have not done anything.

Between them, the 12 senates have only made three recommendations in the past year, and one of those wasn’t about a clinical matter. Does the low grade reflect their scant output, or the quality of the work so far? Would they have got a higher grade by doing more work, or less?

Enigmatic to the last, Sir David.