It is now common knowledge that the Government’s NHS reform programme has been changed over the summer, and inside and outside the NHS there is an expectation that before the Health and Social Care bill goes through Parliament there will be even more changes. The precise role of clinical commissioning groups; the relationship between Monitor and commissioning; the role and function of Foundation Trusts – all of these are likely to change between now and the new year as the Bill completes its Parliamentary journey.

But in amongst all this change one part of the NHS reforms has continued to develop largely unaltered and indeed has been accruing more and more power to itself as the process has unravelled – and that is the NHS Commissioning Board. For anyone interested in the direction of NHS reform this may appear something of a puzzle.