Chris Lancelot on... a really independent nhs

Quite independently, Gordon Brown and David Cameron have suggested releasing the NHS from direct political control.

At first this looks like an excellent idea — the NHS would no longer be a political football. But will removing the NHS one step from the political arena actually achieve anything? I’m not convinced. Setting up a quango to run the NHS may insulate it from direct political interference, but it would immediately become yet another layer of bureaucracy. Anyway, to whom will the new quango report? The government? And what targets will the government set it? We’ll be back to square one again.

I’ve always been in favour of taking the NHS out of the direct political arena, but by itself this is not enough: it must be done in a way that makes the system more efficient.

So let’s imagine that we were starting the NHS afresh, with a completely new infrastructure. How would we design it?

Almost certainly we would want the people at the very top to be clinicians — perhaps a chief doctor and a chief nurse, together with a board of clinical decision-makers — assisted by a patients’ advisory group. This governing body would be advised and supported (but not controlled) by a management team that was lean, efficient and unobtrusive. The clinicians would make the decisions and the management team would then implement them. This pattern would be repeated at all levels within the NHS.

As a result decisions would be made principally on clinical grounds, with constant patient supervision and approval, and management would be subject to clinical control. The NHS would remain accountable — but primarily to patients rather than parliament. In this way it would be taken out of direct political control, while still remaining answerable to its users.

What happens if we compare the quango model with the new model I’ve just described? There’s just no similarity. The new model is much more efficient, and above all fully patient-centric. Nevertheless the quango model is a step in the right direction.

Amazingly the willingness is there on both sides of the political divide. Let us encourage the politicians to continue the debate until they realise that what we actually need is root-and-branch reform of the NHS as a whole.

- Dr Lancelot is a GP from Lancashire. Email him at

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