Doctors often complain of political interference
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The Conservative Party has unveiled its plans to increase the autonomy of the health service.
The party proposes handing day-to-day control of the NHS to an independent board.
Ministers would appoint board members, set objectives and hold it to account - but leave operational matters to doctors and managers.
Experts give their view.
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Gill Morgan, NHS Confederation
Jonathan Fielden, British Medical Association
Dr Hamish Meldrum, BMA's GPs Committee
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Niall Dickson, Chief Executive, King's Fund
Stephen Thornton, The Health Foundation
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GILL MORGAN
NHS Confederation chief executive
"We welcome the Conservative Party's commitment to the values of the NHS and a tax funded system.
"It is good news that that their proposals contain no violent change of direction or major reorganisation.
"The last thing the NHS needs is more reorganisation and upheaval. We need a period of stability.
"The shift from a culture of targets to a focus on outcomes for patients is also a step in the right direction.
"We welcome the proposals to create a more autonomous NHS. Our report "From the ground up" suggests allowing local organisations more autonomy is key to improving the NHS.
"In general our members are convinced about an independent board but we look forward to discussing the details during the consultation.
"We believe that some form of political involvement is unavoidable in a service that spends over £100 billion of public money.
"There is a concern that the creation of an independent board may lead to politics appearing in a less overt and less accountable way.
"What NHS leaders want is genuine autonomy with decisions being made as locally as practicably possible."
JONATHAN FIELDEN
Chairman, British Medical Association's consultants committee
"The BMA has called to remove political meddling from the NHS; an independent board is a key element to this.
"We recently launched our "Rational Way Forward" for the health service and forming an NHS Board of Governors to oversee the NHS was very much part of our vision.
"The Board would be responsible for the day-to-day running of the health service while parliament would decide the high-order questions around setting NHS priorities and funding.
"However we are concerned at the continued emphasis on a "social market" and enhancement of the purchaser-provider split."
DR HAMISH MELDRUM
Chairman, BMA's GPs Committee
"GPs' income is already linked to the success of the treatment they provide and to patient satisfaction through the new contract's Quality and Outcomes Framework (QOF) which acts as a mechanism for performance related pay.
"The QOF requires practices to carry out patient satisfaction surveys and act on the results.
"Treatments given to patients are rooted in evidence-based medicine.
"In addition to QOF, GPs can secure resources for their practices by taking part in nationally agreed enhanced services which rewards them for achieving high satisfaction ratings from their patients on access.
"We would have to be convinced of the need to extend this process of performance related pay any further and be assured it was fair and based on sound evidence of benefit to patients."
NIALL DICKSON
Chief Executive, King's Fund
"The Conservatives are right in trying to offer greater freedom to NHS organisations, to re-engage doctors in managing the NHS and to create greater public accountability and choice - and doing that by building on existing reforms, not by a further potentially damaging reorganisation.
"But we need to be cautious about the value of an independent NHS board.
"Handing power to such a board would not, by itself, guarantee local autonomy or a greater voice for patients.
"The risk is that we move from one centralised system to another - and one that is no longer directly accountable to ministers.
"The Conservative's plan to abolish all central targets also needs to be considered carefully.
"While central targets have certainly brought problems - not least the sheer number of them and some unintended consequences - they have been a big factor in driving down unacceptable waiting lists.
"In the end, those responsible for the nation's health need to maintain all the "levers" for bringing about change: perhaps a smaller number of very meaningful targets; greater accountability at local and national level; strengthened professional practice for clinicians; financial incentives that support good health outcomes, not just activity; patient choice and competition and effective regulation."
STEPHEN THORNTON
Chief Executive, The Health Foundation
"We support the Conservatives' proposals to give NHS clinical leaders the freedom to improve and change services within a framework of standards and regulation.
"Based on our work in safety and quality improvement, we know that more operational freedom for healthcare providers to take control of the big choices affecting the NHS will bring about substantial improvements in the quality of patient care.
"We are delighted to see the suggestion that the NHS under the Conservatives would focus on improvements in measurable health outcomes rather than processes.
"We know from experience that the majority of healthcare professionals want to improve the quality of their services but they are most engaged when they can see how changes have a direct and positive impact on patient care.
"Furthermore, having a regulatory framework in place that actively encourages NHS managers and clinicians to collect and use data is a step forward.
"Data should be used for improvement rather than accountability and should be collected in a meaningful way so that it can be used to bring about changes in practice.
"The next step for healthcare is not about more reorganisation. It is about ensuring there is genuine support for healthcare professionals to measure and report clinical and patient-reported outcomes so that long-term improvements in the quality of patient care can truly be achieved."
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