The King’s Fund has called for the creation of an NHS constitution to curb political interference and devolve real power to local managers.
A report published today dismisses the idea of an independent board as “misguided” and instead makes the case for a constitution that would spell out lines of accountability.
Governing the NHS: alternatives to an independent boardargues for a constitution that could enshrine the principle of subsidiarity - meaning actions should be taken locally whenever this would lead to better outcomes.
King’s Fund deputy policy director Anna Dixon, one of the authors, explained: “For areas like C difficile, it’s still not clear who has ultimate responsibility for the fact that patients have died.
“A constitution could spell out the roles of the board, Healthcare Commission and Department of Health, and where the buck stops.”
The constitution needs to be more than just a statement of core NHS principles and existing targets, the report says.
To make it credible, it needs to clarify roles and relationships and ensure that there are appropriate legal checks on ministerial and departmental decisions.
However it does not go as far as suggesting that the constitution clarifies boundaries on areas such as private sector involvement in the NHS.
An overly prescriptive constitution would “in effect place a preservation order on the status quo”, it says.
Prime minister Gordon Brown supported the idea of a constitution in a new year’s message to staff and the idea is being considered as part of junior health minister Lord Darzi’s review of the NHS.
Mr Brown has, however, also rejected an independent NHS board, an idea that is favoured by the Conservative party.
According to the King’s Fund, a board would fail to remove the NHS from political interference because it would be unable to insulate itself from the high level of public interest in healthcare.
There is “no reason to assume an independent board would necessarily be any more transparent than the Department of Health” as it would be subject to the same Freedom of Information legislation as all other public bodies.
Micromanagement is becoming less common without the need for an independent board, the report points out, citing the example of foundation trusts.
Big reorganisations would be just as likely, as Parliament could still vote through legislation despite the presence of an independent board, it says.
The report puts forward alternative ways of depoliticising the NHS, including strengthening the independent reconfiguration panel and expanding the powers of the Commons health select committee.
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