Freeing the NHS from politics

The proposal to set up an NHS independent board has long been a Conservative party ambition. It is likely that yesterday's promised Health Bill will include provisions to establish an independent NHS board as part of the government's aim to replace the 'top down approach' with devolution of power to doctors and patients, and to rid the NHS of political micro-management.

In 2007 the Conservative party published a document – NHS Autonomy and Accountability – which set out in more detail their ideas for an NHS board. Does this give clues as to how it might work in practice?

The board's stated aim at that time was to ensure consistent standards and access to care across the country and to reduce political interference, which was seen to distort clinical priorities and reduce autonomy of NHS clinicians. Recent announcements have stated its two main functions will be to allocate resources and provide commissioning guidelines, suggesting that the proposals are broadly in line with earlier ideas.

But will an independent board deliver the promise of reduced politicisation of the NHS and increased autonomy?

Our earlier report, Governing the NHS, suggested that it would be challenging for an NHS board responsible for such a significant proportion of public expenditure to avoid coming under political pressure. The current economic context suggests this is likely to be more difficult, with Treasury colleagues no doubt keen to keep close tabs on public spending. It also argued that reduced micromanagement of NHS commissioning was desirable, with a greater focus on outcomes and population health, but that there was no guarantee that a board would resist intervening where local commissioners were failing. In the current context there are likely to be high profile instances where commissioners decide to disinvest in local services. It is difficult to see how a board would not come under some political (or public) pressure to intervene in these cases.

While the ambition to put patients and clinicians at the centre of the NHS and to reduce political interference is a noble one, only time will tell whether an independent board can be just that – independent.

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