Health Secretary Alan Millburn has re-defined the role of the government as the overseer of the NHS. He wants greater community ownership and less state ownership to bring more diversity in local services. This will be done by putting doctors, nurses, and managers, in a position where they can improve services for patients, rather than trying to run the NHS from the top like a nationalised industry.Freedom to manage will be restricted to those hospitals and primary care trusts that earn autonomy. Under the star rating system introduced last year, 35 of the 173 acute hospitals were awarded a three star rating and it is this top category that will receive the greatest measure of management freedom. The three-star trusts could become autonomous, self-governing foundation hospitals with the ability to spend their money as they see fit. They will have the option of establishing themselves as not-for-profit companies. Currently if hospitals sell land, the money would have to go into a central pot, but under the proposed arrangements they will be able to keep it for themselves. Central oversight of performance will be achieved through the national standards framework and independent inspection by the Commission for Health Improvement.
New management teams are proposed for failing hospitals, such as the twelve that failed to secure any stars in last year’s assessment. The new teams will come either from the public, private or voluntary sectors. The proposal to bring in managers from outside the NHS has angered trade unions and Labour MPs. The move has been described as back door privatization, although it will not involve any transfer of assets out of the public sector.