The NHS has reacted with sceptically to plans floated by chancellor Gordon Brown and health minister Andy Burnham to devolve more power to the service and away from ministers.
On the eve of the Labour Party conference, allies of the chancellor put forward plans to take politicians out of the NHS by handing the day-to-day running of the NHS to an independent board along the lines of the BBC board of governors or the Bank of England's independent monetary policy committee.
Meanwhile, Mr Burnham used a pamphlet published by the think tank Progress to call for an NHS constitution, setting out the values and principles of the service and the framework through which any changes must take place. It would be renewed every 10 years in a similar way to the BBC charter process.
'Our vision for the NHS should be a system in which the funding and the policy framework is set centrally by ministers but the service has more operational independence at a local and regional level to carry through necessary changes,' Mr Burnham's article said.
Mr Brown's plans would see ministers retain control of budget-setting and strategic policy direction.
'I want a radical shift of power away from the centre,' he said in his speech on Monday.
'The purpose?was to devolve power and separate the making of public policy from the independent administration of daily business. I believe we must now examine how elsewhere we can separate the decisions that in a democracy, elected politicians must make from the business of day-to-day administration.'
Speaking to HSJ, health secretary Patricia Hewitt said Mr Brown's and Mr Burnham's ideas were 'very interesting' and required further debate.
'We are now at the stage where we need to move from top down to much more bottom up,' she said. 'That means giving staff greater freedom to look outwards, not upwards.'
Ms Hewitt said the need to give the NHS increased freedom was 'one of the reasons I decided to split the job of NHS chief executive and permanent secretary', but commentators were sceptical that policy could be separated from implementation.
NHS Confederation policy director Nigel Edwards said there was a good argument for having an arm's-length body in charge of the provider side. But he added: 'We would all like the idea of a non-political body running the NHS - that's very attractive, but it's a£100bn business. The reality is that you can't walk away from political accountability
'Even if it was run by some board, what about when you shut a hospital in somebody's constituency: they would immediately be up in arms.'
King's Fund chief executive Niall Dickson said: 'Those who have the this idea of taking politics out of the NHS are living in cloud cuckoo land,' he said.
Institute of Healthcare Management chief executive Sue Hodgetts said: 'There is a danger in expecting the same success of the independent monetary policy committee. When the chancellor established this in 1997 it had but one task: to control interest rates. The NHS is far more complex.'
But NHS North West chief executive Mike Farrar backed the idea of an independent board. 'Whenever changes are mentioned, people think that they are always politically driven when they are in most cases driven by the desire to improve care by doing things better.'
The Conservatives accused Mr Brown of having run out of ideas, saying their leader David Cameron had floated the idea of devolving the running of the NHS to a body based on the Bank of England's MPC in an exclusive article in HSJ earlier this year (news, page 6, 9 February).
How NHS Alliance was blocked with board idea in 2000
When the NHS Alliance pushed for an independent board to run the NHS in a report six years ago, it ran into ministerial opposition.
A minister demanded his foreword be removed and the Department of Health slammed the document as seeming to imply that the NHS 'should be turned into a super-quango, unaccountable to the public'.
The alliance's 2000 policy document Implementing the Vision contained detailed proposals for an independent self-governing body which would run the NHS and independently negotiate its own
funding and services.
It was to contain a forward by then health minister John Denham, but hours before publication the DoH told alliance chair Dr Michael Dixon that it had to be removed.
Staff used craft knives and rulers to physically remove the foreword from every one of
the 4,000 copies produced, but the story that the report had been doctored leaked out and led to embarrassing headlines.
Dr Dixon told HSJ this week: 'We have always thought that the day-to-day running of the NHS needs to be depoliticised and said so as far back as 2000 when we had all those problems with ministers.'