Establishing an independent board to loosen the apron strings between politicians and the NHS is being proposed by politicians of all persuasions as a solution to many of the NHS' ills - from rationing to reconfiguration.
An independent board could be part of the solution. But the problems of the NHS are not just about political interference. And it would be strange for politicians not to take an interest in an organisation spending £100 billion of tax payers' money a year.
The NHS Confederation has released a report From the ground up: how autonomy could deliver a better NHS to coincide with its annual conference that is taking place this week in London. The report makes the case for devolving autonomy and increasing accountability within the health service.
We argue that behavioural change, not more restructuring, is the solution to many of the current problems in the NHS. An independent board may be part of the answer, but would not be enough to deliver a truly patient-led service unless it goes hand in hand with real devolution of decision making closer to patients.
The health service wants politicians to deliver genuine autonomy, not to merely tinker with structures. A survey of 337 NHS chief executives and chairs reveals that 91 per cent of NHS leaders agree or strongly agree that better outcomes for patients are achieved when decisions are made at a local level.
In the same survey, NHS leaders also considered a range of approaches to ensuring that decisions can be made at a local level. When asked which method they favoured, the highest response at 44.3 per cent was for changing performance management and regulation to focus more on patient outcomes. The lowest at 4.9 per cent was creating elected local health boards. Just 7.8 per cent said that the creation of an independent board would be the best way of ensuring that decisions are made at a local level.
We have evidence that greater autonomy tends to be associated with improved problem solving, innovation, increased responsiveness and reduced stress levels for NHS staff. However, genuine autonomy is about relationships within the health system - between politicians, civil servants, managers and clinicians. Relationships must be clearly defined and behaviours challenged - or else no amount of structural change will protect the autonomy of frontline services.
An independent board might end up being part of the solution to increased autonomy in the NHS. But we should not forget that some form of political involvement is unavoidable in a service that spends so much public money. Yes, we need to stop politicians interfering in the day to day running of the NHS. But the fear is that many issues and decisions that may end up being devolved to an independent board because they look technical and managerial will actually have value judgements and trade offs that are unmistakably political.
What NHS leaders want is genuine autonomy and accountability, with decisions being made as close to the place patients are treated as is practicably possible. There will always be some issues for which top down solutions are entirely appropriate, but to get the best from the current system, NHS boards must be able to take responsibility for their own fate rather than relying on external targets and scrutiny to drive improvement.
As we enter our conference week, the NHS Confederation looks forward to working with all political parties to deliver the genuine autonomy and accountability that the NHS needs.
The NHS Confederation's annual conference is taking place in London, 20-22 June. From the ground up is available at www.nhsconfed.org
Nigel Edwards
Director of Policy
NHS Confederation
Published in Times Public Agenda on 19 June 2007
