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Views & Reviews Personal View

The health department and the NHS: time to separate?

BMJ 2009; 339 doi: (Published 19 November 2009) Cite this as: BMJ 2009;339:b4881
  1. Nigel Crisp, independent crossbench member of the House of Lords
  1. Crisp{at}

    Many people have argued over the years that the NHS in England would benefit from being separated from the Department of Health and distanced from politics and politicians. The Conservative government acted on just such a belief when it set up the NHS Management Executive and established its headquarters in Leeds after the 1983 Griffiths report. I would put it the other way round: from my experience as the only person to have been both permanent secretary of the department and chief executive of the NHS, I believe that it is the department that has most to gain from such a separation. For the first time it and the politicians would be free to concentrate on the wider issues of health rather than on running the NHS.

    These wider issues are essentially political in the sense of being about the sort of society we want. They are about the choices we make on issues such as smoking, fluoridation of water supplies, equality of access to services, the regulation of practitioners and …

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