Just why is this man the NHS Chief Executive?

Can somebody explain how a man with such little vision and ability as David Nicholson is the NHS' Chief Executive?

Let me give you two recent examples:

• His review of Innovation.  This has produced the proposal that Trusts should comply with national procurement guidance or explain ("comply or explain").  Am I mad, or is this the antithesis of innovation?  Perhaps the official language of the NHS has been changed to newsspeak. 
  
  Perhaps he would like to explain NPfIT, PFIs and other centralised procurement schemes, before he opines on the merits of centralised bureaucracies.  Talking about taking accountability for decisions, when is he going to take responsibility for the mega-folly that was NPfIT for which he was SRO?  Perhaps he can do that before he begins to lecture others.
  
  Nicholson went onto indicate that in principle Foundation Trusts should be brought to follow the same rule, but “Organisational independence [currently] seems to trump value in a big way.”  Isn't that the point of a FT - that it is not run by a bureaucrat based at Richmond House?  More on that below.
• His separation from reality.  In another recent intervention (at the Mid-Staffs inquiry), he proposed that DoH should retain the possibility of de-authorising FTs.  This is contrary to the general shift of policy for 25 years; and is his job not to implement an elected government's policy?  And what is the benefit of de-authorisation?  That it comes under SHA control?  So let us take London: perhaps he can explain to us why SHA control of BHR, Whipps, West Middx, St George's, South London, St Helier and Newham has produced such great results.  Beyond going against government policy, what is his evidence?

All I can conclude is that this man is a bureaucrat with no driving vision; or that his priorities are on other things if he cannot find a coherent vision for how the NHS should function.

The point of Academic Health Science Centres

I have finally figured out the point of Academic Health Science Centres.  It is to create more jobs for the boys (and, more rarely, girls).

As I have commented before, the NHS goes through cycles of structural change.  During these structural changes the top jobs tend to vary according to the point in the cycle.  In the current point, where organisations are being merged, senior jobs clearly drop.

So what does a bureaucracy do when its jobs are threatened?  Find alternative locations to house its own.  And these are the Academic Health Science Centres.

As we know these AHSCs do very little, but they all seem to have a full board and senior leadership team.  For instance, Cambridge has 4 executive, and 12 non-executive members.  Manchester has a lot too - though it is a bit confusing as to what they do.

Now, once you have a board who does very little, and has done very little, what is the next step?  Order a review to help understand what you should do with this pretty organisation which does jack.  And all the better if the review is done by another member of the great and the good, with consulting support by articulate, intelligent, dim-wits.  So Imperial has appointed Ara Darzi; and King's - William McKee; UCL has appointed Edward Lavelle

Militant Manager's view is that if after so little time of such a heralded process, you have to do a review about where to go, the whole enterprise is of questionable value.

But I am not sure about that; I wonder if Lord Turner is available to do a review of that conclusion?