The King's Fund response to David Cameron Health Service Journal article

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Politicians should resist calls for further structural changes to the health service.

That was the message from The King's Fund in response to Conservative leader David Cameron's article published today in the Health Service Journal online, which calls for less political interference in the running of the NHS.

The King's Fund chief executive Niall Dickson said:

'The NHS has long suffered from excessive political control, too much centralisation of power and a lack of responsiveness to patients so we welcome a wider debate. The Conservatives are right that it's not the job of Whitehall to micromanage the health service, but in fairness the government has recognised that the best way to deliver effective health services is to devolve power within the NHS.

'But we do need to do more. The government's role should be to set overall strategic objectives for health care, including setting a limited number of targets or objectives it wishes to see the system deliver. This should be about outcomes government expects from the investment it has made - including how it expects the system to balance issues such as equity and efficiency.

'We also need to be clear that the regulatory and inspection functions are as independent as possible. One way to achieve this would be to make the Healthcare Commission primarily accountable to Parliament rather than directly to the Secretary of State for Health. The foundation trust regulator Monitor's independence could be strengthened by reclassifying it as a non-ministerial government department, thereby giving it the same status as regulators such as Ofwat.

'Of course, you can never truly take the politics out of the health service. Ultimately, the NHS is funded by the taxpayer and there has to be some way in which to control the use of money. But this is not the moment for further reorganisation. The NHS has just been thrown headlong into a major structural upheaval which already threatens to derail reform and place health professionals under severe pressure. Politicians should resist calls for further changes of this kind for at least five years.'

Niall Dickson added: 'The current direction of reform in the NHS is towards less direct control with the creation of Foundation Trusts and more independent providers and this should increase as market incentives rather than top-down management is used to improve performance.

'This is the right approach, but both the government and the regulatory bodies will need to monitor the development of this quasi-market in health care and to ensure that each part understands its role. This will be no mean challenge in what is bound to be a fluid and volatile environment over the next few years'

Notes to editors

  1. For further information or interviews, please contact the King's Fund media and public relations office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.
  2. To read David Cameron’s article, please visit
  3. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health and social care, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.