Cameron speech: Tories elbow their way to the front on independence agenda

Conservative leader David Cameron hopes that the NHS could celebrate its independence in time for its 60th birthday in 2008. We are happy to see him apparently taking the lead from HSJcolumnist Simon Stevens, who four months ago wrote in a piece on removing political interference from the NHS: 'July 5th 2008 is the 60th birthday of the health service. Maybe it should also become Independence Day for the NHS.'

But what are the prospects for the Independence Bill mooted by Mr Cameron during his speech to the King's Fund on Monday? The Conservatives hope to have the bill published by February so they can concentrate pressure on the government in winning cross-party support. Ministers are unlikely to dismiss the idea of supporting it out of hand before then, so it is certain that the issue will remain hot over the next six months.

The National Institute for Health and Clinical Excellence and, even more so, Monitor will be pleased with the support for their own continuing independence. Strategic health authorities will be less happy with the inference that they will become a local arm of the Department of Health, much reduced in power. Their newly appointed chief executives may well support independence, but not if they are merely policing market-management decisions made by an autonomous commissioning board.

The Conservative public improvement policy group feels it is making the running on big ideas these days and will now be concentrating on two key issues: the balance between local decisions, equity and national standards; and what funding the NHS will need after 2008.

Meanwhile, it is playing down the intriguing concept of patients being able to move commissioners (like a US-style health plan).

They say moving the money with the patient is a long way off - although it is arguably the logical outcome of a future where the NHS sees itself as an insurer of the nation's health.