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Independently governed NHS “unnecessary”, says think tank

17 January 2008

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There is a case for an “NHS constitution” to clarify how the NHS is governed, but not for an independent board to manage the NHS, according to a report from think tank the King’s Fund.

Niall Dickson (pictured), chief executive of the King’s Fund, said: “A constitution could provide real benefits but there are dangers if it is not thought through with care.

“A detailed list of patients’ rights could become caught up in endless legal wrangling. On the other hand, a constitution which simply reiterates core principles or restates existing targets, such as 18-week waiting times, without any enforceable rights for patients would lack credibility.”

Yet the report goes on to argue that a constitution that sets out lines of accountability, as well as the roles and relationships in today’s more devolved healthcare system, could help clarify what the NHS is designed to do and how it is governed.

However, the report concludes that as recent reforms have begun to increase the autonomy of health service organisations and reduce central government control, an independent board to manage the NHS would be unnecessary.

Co-author of the report, Anna Dixon, acting director of policy at the King’s Fund, said: “People have legitimate concerns about excessive central control and the ‘politicisation’ of operational decisions in the NHS.

“However, recent reforms creating autonomous NHS providers, patient choice and devolved commissioning and delegated responsibility for regulation have shifted power over the day-to-day running of the NHS away from central government.

“The fact is that control of operations is shared among many bodies in the modern NHS, meaning the Department of Health is no longer the sole, or main, source of rules and regulations that govern NHS organisations.”

The Conservative Party has argued for more independent governance of the NHS, and said that it would remove “political interference” from the NHS.

The prime minister has indicated that he is considering plans for a new “NHS constitution” as part of Lord Darzi’s review of the NHS.

King’s Fund