Nicholson: I feared Lansley’s competition rules

He also suggested health secretary Andrew Lansley was wrong to think he could let GP consortia decide their own governance arrangements – another element now abandoned in the face of opposition.

Sir David was made chief executive elect of the NHS Commissioning Board in December, an appointment widely believed to have been made by Number 10 rather than Mr Lansley.

Speaking at the Commissioning Show in London today he said the amended reform proposals, announced on Tuesday following the NHS Future Forum process, were “a much stronger set of proposals for change than we had before”.

Sir David said the NHS should “absolutely have both” integration and competition. But he said: “[The changes] put competition in its right place – not as a thing we should promote but as a tool commissioners can use to promote standards.

“My fear was unless we got to that place we would have a situation where clinicians and patients could design a fantastic pathway which would be really beneficial, and somehow some regulator would come and say, ‘You can’t do it that way, it is anticompetitive’.

“Well fortunately we have had some debate and it is clear that is not the way competition should work in the NHS. Competition can have a place but it should be driven by clinicians not by independent regulators.”

The government’s changes also include setting clear governance requirements for consortia – now renamed clinical commissioning groups - including a governing board with a nurse, hospital and two lay members. Mr Lansley had previously insisted it should be up to the groups.

Sir David said it was, “important those people are involved, so we should embrace it and make it part of what we do. I think it will strengthen commissioning arrangements”.

He added: “The government did something incredibly brave [by saying] we are going to have these consortia and let them organise themselves in whatever way they see fit. I can’t ever remember a government doing that.

“They couldn’t actually deliver it. It is hardly surprising given the amount of competing interests and vested interests in the NHS that you would get that.”