Sir David Nicholson’s letter setting out his “expectation” that redundant strategic health authority and primary care trust directors should not seek employment in the NHS for six months prompts two questions.

The first is whether Sir David’s message is reasonable. In some ways it is clearly not.

‘In the absence of an NHS chief executive, who will tip the wink to the service in this way?’

If the NHS has immediate need for these people, it should not be denied their talents, something the NHS chief executive admits when he says each case must be decided on its merits.

But Sir David also has the reputation of the service in mind and his letter is a warning to both redundant directors and would-be employers that they will attract negative publicity if they are perceived to be taking the Michael with public funds.

Leaders exposed

The second question is who, in the absence of an NHS chief executive, will tip the wink to the service in this way? Sir David will be able to do it for commissioners.

But it is hard to see Monitor or the NHS Trust Development Authority taking a similar step for providers.

The health secretary might come under pressure to do something similar − but it would undermine the principle the NHS is no longer “run from Whitehall”.

Does it matter? Some would argue not − that individuals and organisations should take responsibility. Others will feel a “national” organisation should take a consistent approach and the guidance is sensible.

On balance, the former is the stronger argument, but some NHS leaders will feel more exposed as a result.

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