New relationship between government and NHS needed to ensure realism, accountability and focus, says The King's Fund

Legislation is needed to set up a new body that could lead to the NHS agreeing realistic improvement targets and then take responsibility for delivering them, says the King's Fund, in a report published today. Government would then be able to focus on developing wider health policy instead of meddling in health care services on a day-today basis, which the present system encourages.

The report calls for a new, more mature relationship between government and the health service. It would involve a more transparent and inclusive approach to setting expectations for national policy, and would enable greater ownership by NHS staff of targets for improvement. It would also enable Parliament to play a much greater role in holding both government and the NHS itself to account for their respective responsibilities.

The King's Fund health policy director Steve Dewar, author of Government and the NHS: Time for a new relationship?, said:

'Far from taking politicians out of health care, this report shows how an arm's length relationship between government and the NHS, with the setting up of an NHS agency, could actually put government, politicians, and particularly Parliament, in their rightful and authoritative place.'

The King's Fund chief executive, Rabbi Julia Neuberger said:

'A wide range of public services, including higher education, housing associations and broadcasting, are now either funded, delivered, or regulated through agencies working at arm's length from government. It is time for a similar model to be considered for the NHS. This is not about creating an old-style public corporation to take over the delivery of health care, but rather an organisation to take responsibility for the implementation of national policy and national targets across an increasingly diverse health care system.

'This new relationship would enable health service managers and professionals to get on with the job of delivering care as they see fit, within an agreed, broad policy framework. Government would be liberated from a narrow focus on the day-to-day issues in health care and move towards a concern about the impact of poverty, environment, food, housing and education on health. It's the logical next step from the reforms which have already taken place to devolve governance for much of the funding, regulation and delivery of public services to more local bodies and arm's length regulators, alongside more flexible ways of holding such bodies to account.'

Under these proposals, the NHS agency would take responsibility for seven main functions, including allocating funds to the NHS and delivering national targets and standards for the service. The proposals would require ministers to put objectives for the agency's work, including targets and standards for the health service, before Parliament. The agency would have a requirement to report to Parliament at least annually and to be subject to regular review by parliamentary select committee. Parliament would hold the chief executive to account, and would work towards integrating regular scrutiny of the NHS with parliamentary debate.

Read the report: Government and the NHS: Time for a new relationship

Notes to editors: 

1. Government and the NHS: Time for a new relationship?, by Steve Dewar, is available priced £6.50 from the King's Fund on 020 7307 2591. The report can be downloaded for free from Tuesday, 28 October.

2. The discussion paper is part of a series of publications from The King's Fund's Shaping the New NHS programme. Can Market Forces be Used for Good?, by Jennifer Dixon, Julian Le Grand and Peter Smith, was published on 19 May 2003. What is the Real Cost of More Patient Choice?, by John Appleby, Anthony Harrison and Nancy Devlin, was published on 5 June 2003. A final paper examining chronic disease management will be published in December 2003.

3. For further information, interviews with the author or review copies, please contact Daniel Reynolds in The King's Fund public affairs office on 020 7307 2581 or 07831 554927.