The “surprising” appointment of David Nicholson to head up the new NHS commissioning board may have been prompted by growing government concern about the NHS reforms, HSJ has been told.  

Last week’s appointment of Sir David, the current chief executive of the NHS, as chief executive of the new commissioning board has been widely welcomed for the continuity and stability it brings the NHS.

However, the appointment came months ahead of schedule and precedes the appointment of a chair or any other members of the board.

Nigel Edwards, acting chief executive of the NHS Confederation, said: “I think it’s a smart move in as much as it means you’ve got someone who is trusted to deliver in the saddle doing it now. I suspect it’s quite an important part of reassuring some of the people in government who might have been nervous about the implementation process that there is a safe pair of hands in charge.”

Health secretary Andrew Lansley made the announcement at the NHS chief executives conference the day after the Commons health committee published their report criticising the government for not setting out a clear “narrative” of how the planned £15-£20bn NHS efficiency savings could be achieved.

Mr Lansley told delegates Sir David had the “knowledge and experience to drive through the ambitious reform programme ahead and to provide leadership and continuity”.

Neil Goodwin, director of healthcare management consultants GoodwinHannah and a former NHS chief executive, said: “Concerns are emerging across the NHS, and I suspect across other parts of government, about the risks associated with these reforms. Minimising risk around implementation is terribly important and David Nicholson is the obvious person to do that.”

The original timetable envisaged the appointment of a shadow board next spring followed by the chair and chief executive in autumn 2011.The NCB should be up and running by April 2012.

NHS North West chief executive Mike Farrar said Sir David’s appointment meant the shaping of the NCB could “move forward a bit faster” which would be reassuring for many in the service who were anxiously waiting to see what it would look like.

“I think [the appointment] is really good news for NHS management,” he said. “I think it signals the importance of keeping some of the achievements that we have made over recent years going forward.

“In terms of stability and continuity it links where we have been with where we are going…[The NCB] was going to be one of last pieces of the jigsaw but now we have got David in place we can start to see the architecture.”

Mr Farrar said the decision to appoint sooner rather than later was likely to have been prompted by concern “about the gap and the vacuum that was left”.

Frank McKenna, healthcare director at the recruitment consultancy Harvey Nash believes the public concerns raised by the health select committee and its chair, former Conservative health secretary Stephen Dorrell, have played a part in the unexpected appointment.

“It’s a hugely surprising but clearly compelling [appointment] because of the scale of the change. I suspect Lansley has come under pressure from within the Tory party. Stephen Dorrell’s interjections must have been pretty stinging. This will be Lansley’s legacy and irrespective [of whether] there is any love between them he must respect [Nicholson].”

Mr Dorrell welcomed Nicholson’s appointment but declined to comment on whether his intervention had prompted the appointment.

He said: “I think that’s very good news. It creates clear strong leadership at the centre of the reform process. It’s a good step forward.”

However there are also concerns about Sir David’s alleged centralising instincts which could conflict with the government’s reforms.

Deputy chair of the BMAs GPs committee Dr Richard Vautrey called for Mr Nicholson to spend time getting to know how GP services worked before pressing ahead with the roll out of commissioning consortia.

He said: “David Nicholson has given the impression that he’s not been a wholly enthusiastic supporter of the white paper proposals. His focus has been QIPP [the quality, innovation, productivity and prevention agenda].”

Mr Farrar said Sir David would want to “get the balance right” between centralisation and handing more power to frontline clinicians.

The Department of Health said Sir David would fill both roles until March 31, 2012 when the role of chief executive of the NHS will cease to exist.  A chairman will be appointed during 2011-12.