Published in Tribune 1 June 2007

Suresh Pushpananthan argues that an ‘independent board’ running the NHS must not allow privatisation by stealth.

It is rumoured that Gordon Brown will answer his critics, who accuse him of ‘control-freakery’, by giving the NHS greater freedom to run it’s day-to-day business. The policy would be a feat to match his early decision to make the Bank of England operationally independent. The success of that reform, which has helped keep the economy stable over the past ten years, still redounds to his credit.

The policy has obvious merit compared with the past ten years where Ministers have tested micro-management to destruction, setting reams of targets that have tied managers and doctors in knots. Far too many initiatives have been rushed through without being tested or thoroughly thought out.

If the proposal for increased independence does go ahead, Ministers would be kept at arm’s length, and their job would be limited to setting the annual budget and overall strategic objectives. An independent board would be given the operational freedom to decide how best to meet those objectives.

Brown is likely to be concerned about handing over total financial control. Who is going to pick up the pieces if there is a large overspend? Will the Government really leave it up to the board to decide which services are to be rationed if healthcare costs continue to soar and more treatments become available? There are still more questions than answers.

Surely the policy could only work if the NHS’ objectives were enshrined in a charter that set out the service’s core values, clearly identifying what patients can expect from the NHS and what it could expect of them? Any charter would require the NHS to deliver improvements in productivity across the whole of healthcare instead of the narrow measures of hospital performance which are the headline-grabbing, politically attractive policies that have traditionally been utilised. Gordon Brown should seize this opportunity to ensure that the Labour values of decency and fairness are enshrined within the NHS and that the service continues to provide healthcare that is both comprehensive and universal.

With David Cameron also expressing an interest in making the NHS more independent, it is on these detailed issues of design that discussion should now focus, rather than the actual principle of making the break with an increasingly anachronistic nationalised industry model.

By giving control of an organisation, with a budget of 0.3% of the entire GDP of the world, to an independent board we must be certain that there is adequate protection in place from private interests wishing to loot the NHS. Healthcare expenditure is rocketing not just because demand is rising but also because healthcare markets do not work efficiently. They are dominated by increasingly powerful companies and influential doctors who find it easy to pass on ever-rising costs from new medical technologies to the taxpayer.

The greatest risk of taking politicians out of the day-to-day running of the NHS is that greater privatisation can enter through the back door – enabling politicians to evade blame for it. Conversely, however, there exists a unique opportunity to enshrine Labour values within a reformed NHS ensuring that the Tories are not able to privatise the service by stealth further down the line.

Private companies should be welcome to tender proposals and compete fairly within the NHS to provide services where the NHS is not able to meet capacity. The private sector should be used to support rather than supplant the NHS. The current map of for-profit providers within the NHS currently comprises a few well-placed companies that have selected plum contracts providing the easiest care for the most profit. We must ensure that our NHS does not end up looking like the very market which it was initially designed to protect us from.

We should be cautious about rushing into another ill thought-out reorganisation – the NHS has seen far too many of these already. However, there now exists a unique opportunity for the NHS to enjoy a level of independence that it has not seen previously – and this should be encouraged.

Suresh Pushpananthan is a specialist registrar neurosurgeon, lecturer in neurosurgery and a member of the Central Council of the Socialist Health Association.

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