Webster urges setting up NHS commission

Giving the Office of Health Economics' annual lecture last week, Charles Webster said a body 'along the lines of the Law Commission' could undertake radical research and 'bring to bear a greater weight of intelligence than has been brought to bear by any other course of action' on policy making.

In his lecture, 'National Health Service Reorganisation: learning from history', Dr Webster noted the NHS was facing its third major reorganisation since 1948 and its second since the start of the 1990s.

He argued vested interests and political imperatives had impelled previous reorganisations, and said the present government was repeating the pattern.

The problem with such major overhauls, Dr Webster argued, was that they tended 'to replace one set of unsatisfactory structures with another, leading to more pressure for change which comes at an ever faster rate'.

He called for more 'rational' and 'evidence-based' decision making, and welcomed the creation of bodies such as the National Institute for Clinical Effectiveness and Commission for Health Improvement.

He said these represented the 'recreation of the central advisory services that were swept away by the Conservative reforms', but argued they were 'too fragmented' to play a strong role in strategic policy making.

An NHS Commission, he said, would be a 'logical extension' of these developments, which would also be able to give a voice to patients and the community.

'There is now no hope of getting elected people involved in the management of the health service so a commission would be the last hope of getting patients' views heard,' he claimed.

In response to questions, Dr Webster also expressed reservations about giving more power to GPs: 'In the 70s, there were very serious qualms expressed about putting the health service into the hands of the robber- barons. I am by no means sure that we will look back at this move as a good one.'