NHS needs more freedom from political control and centralised management, says The King's Fund discussion paper

Radical changes are needed to the way the NHS is managed, according to a discussion paper published today by The King's Fund.

The Future of the NHS is based on the work of a group of experts from health and other sectors, chaired by Lord Haskins, Chairman of the Better Regulation Taskforce.

The Future of the NHS argues that the NHS provides a good service in many ways, and that changing the way it is funded is not the most important task facing the government. But it proposes three fundamental reforms of the way the NHS is managed

  • At the national level, legislation is needed to set up a corporation to manage the NHS at arm's length from the Government. The corporation would have responsibility for allocating funds across the NHS, regulating health care and setting standards for services; while the Government would provide funding and control health policy.
  • Locally, existing NHS health care providers should be re-established as new types of not-for-profit organisations with strong local accountability. They should have complete control of how they use their assets but remain publicly owned and work to national standards of care.
  • At all levels, patients' views should have a more direct impact on shaping and developing services. For example, patients should be given more choice about how their own health care is managed, including where, how and by whom they are treated.

Lord Haskins said:

'The NHS is not in crisis. It is not on the verge of collapse. But it does suffer from excessive political control, too much centralisation of power, and a lack of responsiveness to patients.

'Given sufficient funding and staffing, the NHS can provide the world class service the public demands. Our approach to reform, implemented carefully over time and backed up with legislation, would give the NHS the best possible chance of meeting its ambitions.'

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

'The government has said it wants to devolve power within the NHS, and has begun to do this in some cases. It is vital, however, that decentralisation happens across the service, not just in the best NHS trusts, and that it is protected over the long term.

'The whole of the NHS should be freed from political control of its day-to-day workings. Local NHS organisations should be able to manage their assets without interference from the centre and without the constant threat of reorganisation. They should be accountable directly to the people they serve, both locally and through Parliament. And they should be able to offer patients genuine choices about how they are treated.'

Download the report: The Future of the NHS

Notes to editors: 

The Future of the NHS will be launched at a breakfast discussion at The King's Fund, Cavendish Square, London W1, at 9.00am on Thursday, 24 January 2002. Speakers will include Lord Haskins, Rabbi Julia Neuberger, John Appleby and Steve Dewar. Journalists are cordially invited to attend.

For a review copy of the discussion paper, or interviews with the authors, please contact Andrew Bell on 020 7307 2585 or 07831 554931, or Daniel Reynolds on 020 7307 2581.


Lord Haskins
Chairman of the Better Regulation Task Force


John Appleby
Director of Health Systems, King's Fund

Steve Dewar
Fellow, Health Care Policy, King's Fund

Jennifer Dixon
Director of Health Care Policy, King's Fund


Professor Nick Black
Professor of Health Services Research and Head of Department of Public Health and Policy, London School of Hygiene and Tropical Medicine

Anna Bradley
Director, National Consumer Council

Sir Cyril Chantler
Chairman, Great Ormond Street Hospital and Chair of Standards Committee, General Medical Council

Professor Sandra Dawson
Director, The Judge Institute of Management and Master, Sidney Sussex College, Cambridge University

Pippa Gough
Fellow, Education and Leadership Development, King's Fund (previously Director of Policy, Royal College of Nursing)

Sir Graham Hart
Chairman, King's Fund

Anatole Kaletsky
Associate Editor, The Times

Rabbi Julia Neuberger
Chief Executive, King's Fund

Linda Smith
Chair, Lambeth, Southwark and Lewisham Health Authority

Sir William Wells
Chairman, NHS Appointments Commission

Contributions were also made by Anthony Harrison, Fellow, Health Systems, King's Fund and Professor Julian Le Grand, Richard Titmuss Professor of Social Policy, London School of Economics and Political Science.