Roll up, roll up: the great commissioner-requested services bun fight is coming to a council chamber, local rag and Save our DGH campaign near you.
CRSs, you will recall, are those services which will be subject to more regulatory controls from Monitor than others because commissioners think they might be “essential” and need “protecting”.
However, ministers haven’t the guts to allow them to say so up front in case the implication for “non-essential” services becomes apparent to Joe Public.
Thus, CRSs will be “designated” for extra attention from their loving regulator, which will only decide if the service truly is worthy of protecting if and when financial failure brings the issue to the fore.
Or to put it in layman’s terms: while CRSs might stand a fighting chance, non-CRSs are unprotected services, liable to closure at the whim of a management consultant’s spreadsheet or bank manager’s final demand.
The potential political hot potato, then, will not so much be the designation of services, but their non-designation. And it is precisely this issue that Monitor has now proposed to ramp up. Original plans were that the vast bulk of all foundation trust services would start under the new regime as “designated”, and then be quietly de-designated as and when commissioners got around to thinking about it.
Following consultation earlier this year, however, it appears Monitor now shares the view that, left with free hands, newbie GP commissioners will sit on them and leave existing FT services “designated” for protection, whether they need it or not.
Monitor’s revised proposals now include time-limiting designations so that they expire after, in Monitor’s example, three years, and are only renewed if commissioners actively opt them back in.
For clinicians staffing individual NHS services that don’t make it - and the patients and campaigners that support them - the process was always going to feel akin to being switched from a permanent employment contract to a series of rolling but insecure fixed-term gigs.
But by imposing a time scale over the process, Monitor’s proposal adds to this mix the possibility of an avalanche of national scandal over hypothetical NHS closures.
With a working timetable of 2016, ministers might avoid the fallout from that, but NHS managers, it seems, will not.
Sally Gainsbury is a news reporter for the Financial Times, firstname.lastname@example.org