Gordon Brown has talked about creating an NHS that is more independent of central government, but are structural changes really the answer? There have been significant improvements in the NHS but public opinion of the service is at an all time low. Frequent reorganisations have been particularly poorly perceived.

The focus for the new prime minister should be on delivering real autonomy for the health service; improving the patient experience and bringing everyone in the NHS family together.

Front line staff, including both managers and clinicians, must be made to feel that they are not just instruments of public policy but are free to pursue patient interests. The key to providing a patient-led service is not to create an independent board of advisors but about giving the NHS genuine autonomy so that decisions can be made locally. Local organisations should be encouraged to use their own initiative and good governance and not have to rely on external scrutiny to drive improvement.

Improving the patient experience must also be key to any reform of the health service. We should be measuring actual outcomes for patients, not chasing process driven targets, and making sure that the NHS can deliver good care as well as the best of modern technology.

Finally, the new prime minister must work to bring the NHS together. Following a very difficult year, all partners involved in the NHS - including unions, colleges, local government and trusts - must now come together to provide solutions and ensure staff are motivated and able to do their jobs. Leadership from Gordon Brown and the new health secretary will be crucial for this.

Nigel Edwards
Director of Policy
NHS Confederation

Published in British Journal of Healthcare Management on 1 July 2007