At the heart of a long-term vision for the NHS set out last week by the BMA, was a proposal to rein in politicians’ involvement with day-to-day management of the service.
In ‘A rational way forward for the NHS in England’, the BMA proposes an independent board of governors, appointed by parliament to oversee the management of the NHS by an executive team including the CMO, NHS chief executive and SHA chief executives.
With reduced management responsibility, the BMA proposals said, politicians would be able to tackle a far wider range of health policy issues, particularly public health.
But the primary motivation would be to cut political ‘dabbling’ with the NHS. Keeping politicians at arm’s length could help insulate the NHS against knee-jerk policy changes, the BMA believes.
The BMA is not alone in proposing the move. A Conservative victory at the next general election would make independence more likely as the party has called for less political involvement in running the NHS.
However, Labour leadership front-runner chancellor Gordon Brown has also been linked with the policy, which some reports said he would implement if he becomes prime minister, echoing his decision in 1997 to set the Bank of England free from direct political control.
Some analysts believe there are signs that the plans are taking shape already. NHS chief executive David Nicholson announced last week that he is carrying out a reshuffle of the NHS leadership which has been interpreted as potentially the first step towards an independent NHS.
However, prime minister Tony Blair is opposed to the plan and has indicated that an independent board for the NHS is unlikely.
Health minister Andy Burnham last week echoed this stance.
‘Devolution of power was happening under current reforms, and suggested devolving power to a central NHS board could create a “top-down” NHS,’ he said. ‘Politicians are accountable to the public and I don’t think what the NHS needs is less accountable people.’
Deputy director of policy at the King’s Fund, Anna Dixon, said the King’s Fund was in the process of writing a report on the issue and was ‘ambivalent about the idea’ at this stage.
‘There is already a lot of independence through NICE, the Healthcare Commission and foundation trusts. The notion that politicians are involved in the day-to-day management of hospitals is just not true,’ she said.
Despite speculation about the motives behind his changes to NHS leadership, David Nicholson has spoken out against independence for the health service.
Speaking at an Institute of Health Management (IHM) conference last week he said: ‘There has to be democratic accountability when it comes to the spending of £90 billion of taxpayers’ money.
‘The involvement of politicians, contrary to popular perception, is not a hindrance to the NHS, it gives us legitimacy and they are crucial to securing us the funding.’
Nevertheless, speculation about the policy shift continues to mount, and many believe it could happen and could work.
Board of governors
Dr Julius Parker, medical director at Surrey and Sussex LMCs firmly supports the idea of an independent board of governors.
‘What happened with the Bank of England has been a success, enabling decisions to be taken away from the political arena. Such a move with the NHS will be as successful,’ he said.
But resistance to such a plan will be strong even if a new Labour leader backs NHS independence.
Sue Hodgetts, chief executive of the IHM said: ‘The notion that politicians do not have a legitimate oversight role is, perhaps, fanciful.
‘Managers understand the running of the NHS must have total transparency. That means being answerable to elected politicians.’
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