David Bennett, boss of Monitor, is leaving; I'm so pleased I could almost pay for his leaving party. Almost.

Quite why he was worth £280k a year always defeated me. I judged him a poor public speaker and I honestly don't think he could inspire me to sit in a puddle if my trousers were on fire.

He was dealt a bad hand but I think he has played it badly.

It was once the political fashion to think that the private sector could lever up NHS quality and drive down costs. Neither has happened; Serco, Circle, Saga, BUPA, and who knows, inevitably, Virgin and a third of care homes, bear testimony.

In consequence a health 'market' required regulation. Better our own Off-Sick (like Off-Wat and Off-Sted) than the office of competition and thuggery.

Bennett seemed to struggle from the off. A combination of austerity, untrammelled demand, a hopelessly confused management structure and chaotic political objectives made Monitor unworkable. Add to that the obvious need for cooperation not competition and a carved up, cherry-picked NHS becomes unviable.

Bennett should have said to Ministers; 'This job is undoable'. However, he soldiered on, getting himself, ministers and the NHS into a deeper mess.

On Bennett's watch FTs proved to be no better at managing their affairs than non-FTs, their quality no better. The FT brand, with a few exceptions, down the plug hole. Bennett has overseen failure. Recently he has spitefully turned on the sector he was hired to husband.

What's next?

The TDA will be shoved up the back passage of Monitor and end up sharing an office with the cleaners.

There is no prospect of the private sector making a margin in the NHS. The funding too precarious. Monitor is as relevant as Radio Luxembourg. Ministers should dump it but dinosaurs like the Plastic-Peer, David Prior, who has ministerial responsibility for the Regulator, still cling on to a Thatcherite past.

In my view, Prior led the CQC into an expensive blind alley, now he'll do the same to Monitor. The NHS does not need Monitor... neither does Tarzan and neither does the Tinker-Man.

The NHS needs to circle the wagons; find the key to greater productivity; being busy isn't, necessarily, being effective. About 1.5% is the average year on year efficiency gain; 0.4% the recent ceiling. Tarzan needs 3%. My guess, Vanguards are too slow off the mark, he will need 5% to catch up.

Some tough truths must be told.

Don't give Primary Care any more to do, it is beyond rescue; too small, fiddly, poorly led, premises mainly too small, too few skilled staff, too clunky and too loved and blinded by a romantic past to have an objective future.

Vertical integration with secondary care is the only fast, practical solution. Population based, capitated budgets. Get on with it.

CCG's look to me they are drowning, drifting and dying on their feet. No outcome measures. Forget commissioning think, integrated care organisations for 500k populations... minimum.

Too many Trusts boards missing quality issues, treating staff like cannon fodder; the fact there are so many board vacancies and the average tenure of a CEO, just over two years, says it all.

Dump all targets and recalibrate what we measure.  Share back-office functions and leverage buying powers.

St David's idea that you can run a chain of Trusts is barmy. It's hard enough to run one. Only Hubris would try two. Only Maniae would attempt three.  Only Arcesilaus would suggest more.

Turn Trusts into social enterprises and let the staff and the communities they serve, own and run them.

NHS IT? Too ambitious and too confused. Focus on the basics. For instance; nurses take observations, recorded by equipment that could connect to the patient record system. Instead, they write results on scrap paper and rewrite them into patient notes. Dangerous...

All Trusts must have a Route One of rock-solid Wi-Fi. Offer it free to patients and outpatients and visitors in exchange for email addresses; like coffee shops. Compile public health mailing lists and yes accept advertising from pharmacists and grocers to pay for it. Sponsorship? Yes, get over it.

Public Health England does everything from Porton Down to sun cream advice. Confusing, sprawling, unmanageable; break it up and privatise the public information bit.

Dump commodious NICE and do a deal with SIGN to evaluate drugs.

The CQC? As Tarzan says; if regulation was going to improve healthcare, it would have done it by now. Close it and reinvent Community Health Councils.

The truth; we don't need Monitor. A tandem of the Carbuncle and Monitor gives us 2 leaders, two overheads, tension and trick cycling; Laurel and Hardy in the making.

If we have to have a tandem, it'll take Irvine and Mitchell. 

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