Leader: Sir Nigel's successor must curtail the mess

The departure of Sir Nigel Crisp from the top of the NHS tree should not be seen as drawing a line under the current multitude of health service problems. The risk of the almost ritual removal of a chief executive is that those left behind assume the problems have departed with the scapegoat.

Sadly not much will be rosy in the garden for temporary NHS chief executive Sir Ian Carruthers, or Sir Nigel's permanent successor. But they have been presented with the opportunity to halt the current reforms and determine the best way forward. The new broom will have the advantage of taking an overview of the situation, while many of those close to the reforms may well have lost perspective.

The problem with many of the current changes is that individually they are reasonable ideas, but not enough thought has been given to how they link together.

Paying hospitals for the work they do is sensible, as long as they don't start performing unnecessary tests and procedures. But it should have been introduced in tandem with practice-based commissioning (PBC) rather than the current disjointed approach. Using private firms to cut waiting lists may have seemed obvious, and paying for procedures up front may have been the best way to close a deal but it makes little sense in the era of PBC and patient choice. And if this wasn't enough, while SHA and PCT reform may be necessary, it was folly to push it through while all the above initiatives were coming on stream.

This mish-mash of poorly meshing policy has to be the number one priority for the new NHS boss, and calling a temporary halt to the whole mess his or her first duty. A pause to review and correct is surely the NHS's only possible course at this time, and a new leader may have a brief opportunity to curtail the policy of running public services for the benefit of election manifestos.

Clearly an understanding of grass-roots health provision and the ability to stand-up to ill-informed politicians and reject ill-thought-out policies are the criteria for the new Sir Nigel.

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