Seven questions about the Government's NHS announcement

by Paul Goodman

• What does the Government understand the NHS Future Forum's "core recommendations" to be, since it's accepting them?

• Who exactly will sit on the new commissioning bodies - Andrew Lansley referred to "full expertise" during the press conference earlier - and what guarantee is there that PCTs won't now first be scrapped, and then in effect re-invented (especially since they look to sit alongside clinical senates and patients' patients)?

• Will the new commissioning bodies be entitled to ignore the advice of the new clinical senates?

• If Monitor is to be required to promote both choice and collaboration, which will comes first?

• Will all these changes save or cost more money than the proposals originally contained in the Health Bill - and in either case, how much?

• Has an assessment been undertaken of whether they will produce better clinical outcomes than those proposals - and, if so, will the Government publish it?

• Since they'll be enacted in amendments to the health bill, shouldn't we hold fire in trying to work out what they mean in full - and who's won and lost - until those amendments are published?

5.30pm Update I think we now have enough material from the Government's response to the Future Forum, David Cameron's speech this morning and Andrew Lansley's Commons statement this afternoon to work out the answer to my first question, and part of the answer to my second.

• Core features.  The core features are new purchasing bodies called Clinical Commissioning Groups [CCGs].  These will be co-terminous with local authorities, and eventually replace the present PCTs - which will go in 2013. However, the CCG's won't automatically take their place: a national governing body called the NHS Commissioning Board will decide the timetable in each case, and until they're deemed ready "the local arms of the NHS Commissioning Board will commission on [their] behalf".  The entry of "any qualified provider" into this system will also take place more slowly.

• The work of CCGs will be advised by the clinical senates I refer to above, as well as by clinical networks of specialists.  There will also be new Health and Wellbeing Boards involving local authorities.  Monitor's "core duty will be to protect and promote patients’ interests".  There are various safeguards against privatisation and cherry-picking.

• Clinical Commissioning Group membership. There will be a governing body.  It must contain at least two lay members, "one with a lead role in championing patient and public involvement, the other with a lead role in overseeing key elements of governance such as audit, remuneration and managing conflicts of interest".  Furthermore, we do not intend to prescribe in detail the wider professional membership of the governing body, but it will have to include at least one registered nurse and one doctor who is a secondary care specialist".  This gives rise to further questions about the means by which these people are to be selected.

My five remaining questions stand entirely.  I'd get back to the total of seven by adding two more.

• Is there a deadline by which all CCGs are expected to be in place?

• If not, what's to stop the new NHS Commissioning Board from exercising central control for quite some time - a point raised pertinently by the F.T's Nicholas Timmins?