David Oliver: What functions should remain within NHS central government agencies?

Abstract

The latest major reorganisation of the NHS’s government departments and central agencies1 begs the hypothetical question of which functions can best or only be served by central bodies operating at national level. Hypothetical or not, I do have to give the question some empirical constraints. First, data from the British Social Attitudes survey2 and other big datasets such as the Health Foundation/Ipsos rolling polls3 on public perceptions of the NHS show little support for a wholesale shift away from a tax funded, universal, free-at-point-of-care health service and continuing support for the NHS’s founding principles, even though public satisfaction with the current service is at a record low.4 Second, even within universal healthcare systems in high income nations with publicly funded services rather than insurance or copayment models, the NHS is arguably the industrialised world’s most centralised.56 Several others have more devolution of power and accountability to regional administration, …