Independence day?

Politicians seldom admit that their presence may not be strictly necessary. But the debate over NHS independence, launched in the BMJ in 2006, has inspired some soul searching. Has political meddling held back progress or interfered with the ability of medical professionals to deliver the best possible service for the money? Might an independent NHS, shorn of day to day management by ministers, work more smoothly and harmoniously?

Among those in favour of the proposition are David Cameron and Andrew Lansley of the Conservative party, the Council of the BMA, policy analyst Chris Ham of the University of Birmingham, top NHS manager Mark Britnell, and Gordon Brown.

Among those against are Tony Blair, Alan Milburn, the health minister Andy Burnham, John Appleby of the King's Fund, Nigel Edwards of the NHS Confederation, and Gordon Brown.

The future prime minister's presence on both lists is no accident. He famously likes to keep his ideas to himself and a small group of confidants and has (so far as I can establish) never expressed a view on the issue in a speech or article. But he has “let it be known,” first before the 2006 Labour conference, that he favoured NHS independence1 and then in May this year that he does not.2 Neither of these expressions of opinion was more than a nod and a wink to journalists, so we really do not know what Mr Brown thinks. That's the way he likes it.

However, it was Mr Brown who, without advance warning, gave the Bank of England independence to set interest rates, and this precedent has fuelled the speculation. The fact that Mr Blair went out of his …