Last week’s public accounts committee report on the NHS landscape states: “Most important, the department has not yet got a framework to deal with failure in the system, be it on the provider side or the commissioning side”.

Ouch. Difficult word, failure. To a public service used to finding a positive gloss for almost everything – health not illness, “living with” rather than “suffering from” – plain “failure” seems barbarous. Can flattery soothe the dull, cold ear of failure? Sadly, it can’t.

Now, this is the parliamentary committee generally known for arriving after the battle to bayonet the wounded. It doesn’t often review legislation in progress so this is more than just another worthy report on where the reforms are getting things wrong. And its remit isn’t limited to financial failure: it covers anything that taxpayers’ money buys. It is a force to reckon with.

But there’s nothing new here, you say. Ever since the first foundation trust was created there has been uncertainty about the insolvency regime. Would government actually let an NHS hospital go bust? DH officials prefer to hope competition will raise everyone’s performance. 

So vagueness and innuendo (“we won’t necessarily bail out a failing hospital”) ruled. This cost the NHS hard cash. Borrowing costs rose, for loans underpinned by government are always safer and cheaper.

But in a world of any qualified provider, with mental health and community providers lacking the security of a national tariff and a score of NHS trusts too burdened to meet the foundation trust criteria, a failure regime is a sad necessity. Even GP practices can sometimes struggle. The PAC is exactly right. 

But a failing commissioner? It’s a timely reminder that consortia will be very different financial entities from primary care trusts. With £20bn to save there may be a casualty or two. Could the concept of any qualified commissioner (presumably world class) be just around the corner?