The NHS is unsustainable in its present form and should be run independently, according to a Nuffield Trust report.

The report, by Brian Edwards, emeritus professor of healthcare development at Sheffield University, warns that in parts of the UK the NHS is 'in danger of being encased in political ice' and argues that changes to the NHS's structure are essential.

An Independent NHS: a review of the options proposes seven alternative models for removing the NHS from political control, but favours a model similar to the BBC.

This would see the NHS managed as a national service, incorporating both commissioning and provision.

All publicly owned assets, including those currently owned by foundation trusts, would be transferred to the NHS 'corporation'.

Achieving integration

Professor Edwards told HSJ: 'If things don't change, we will end up with independent hospitals that are difficult to get to work around patients. It will be a fragmented system and I think modern medicine demands an integrated system.'

The former chief executive of Trent and West Midlands regional health authorities said he hoped his report would move the debate on from the vague comments made in the past by politicians, including future prime minister Gordon Brown, in support of an independent NHS.

Under other scenarios, the health system would be a managed by a modernised NHS executive within the Department of Health, a commissioning authority, a regionalised system, a service commissioned by local government, a public insurance company or a planning and commissioning corporation.

All options would see the NHS remain a tax-funded system, with ministers acting as the 'guardians of the founding principles of the NHS'.

The DoH would shrink but take on an enlarged role in public health, while non-executive directors from outside the NHS would 'reduce institutional thinking and challenge traditional attitudes'. Workforce planning could be removed from the DoH altogether and placed in the hands of an arm's-length body.

The main advantages of such a system, Professor Edwards said, would be to 'create distance from the heat of political battle' and to develop a 'managerial rather than a political culture'.