'Without a link to elected people, the board would feel adrift and vulnerable.'
Would a Gordon Brown premiership bequeath an independence day for the NHS? Could the man who set the Bank of England free from political fiddling retain the same boldness, even it were to implement a vision that the Blair government has already in large part set in motion?
Last weekend, just before the Labour Party conference began, the government floated the idea of a charter for the NHS that would set out its core principles and rules of engagement. At the same time, Bownites talked about the need for an independent board to run the NHS.
Although not really new in themselves, these are both ideas that should appeal to Mr Brown, whose admirers stress his interest in making clearer the values of the NHS. One interpretation is that BBC-style governors would be custodians of the charter.
Central to this constitution would be a definition of what exactly a market in healthcare means and therefore what the balance of public and private provision might be. The health secretary has ruled out an arbitrary upper limit on the proportion of care done by the private sector. All the more reason that those around Mr Brown, who is much more circumspect than the prime minister about the limitations of the market, would want some principles in place.
Would a charter succeed in giving what health minister Andy Burnham calls 'permanent reassurance about our enduring values'. It seems unlikely that merely having a constitution for the NHS, whether or not enshrined in law, will somehow confine debate to a safe and limited set of issues.
That is the hope that Mr Burnham expressed last weekend, but the BBC's charter does not protect it from widespread debate and dissent, and the broadcaster holds nothing like the same emotional and practical significance for the public as the NHS. No-one marches against the axing of TV programmes. And the BBC is a lot cheaper.
However, there is a strong argument that the NHS is in particular need of an agreed set of guiding principles. The Labour conference illustrated just how far apart some of the players are in terms of what the NHS is for and how it should operate. Mr Burnham's hope is for a wide debate driven not by ministers or the Department of Health but by the service and the public - given extra impetus by the 60th anniversary of the NHS on the horizon.
The idea of an independent board is also fraught with questions. What would it control, and could it include both providers and commissioners? It would surely be a fundamental step back if its remit was to include provision, but if its activities were restricted to commissioning what would its relationship be to strategic health authorities?
Would it simply become - to use a favourite phrase of Mr Brown's - a moral compass for the NHS or would it have real leverage? And what exactly would the board be independent of? Without a link to elected people, it would feel adrift and vulnerable. If there is one thing worse than being politicians' plaything, it is being ignored by them.
Although there will be a lot of appeal for managers in 'taking the politicians' out of the NHS, it is a forlorn hope that one can take the politics out of it. In fact, the NHS will, if anything, become more political at a local level. Managers may feel a nostalgia for the echo of dropped bedpans in Whitehall when they have had a few years of them echoing around myriad council chambers.
So before embracing this week's
ideas too enthusiastically, it would be wise to consider more carefully the dangers as well as opportunities on offer. And for that reason, when one reflects on a Labour conference that sometimes felt heavy with ennui, what seem rather obtuse and abstract concepts do deserve much deeper attention.