To achieve meaningful change at the national level requires a huge effort

Paddy FitzGerald

A mixture of government centralisation, bureaucracy and short-term initiatives in the past five years have impacted on the independence of boards.

And nearly three quarters of board members believe their autonomy has been eroded in the past three years.

Over 50% of NHS executives felt the adverse effects of bureaucracy, with nearly 25% of those questioned saying they did not have sufficient resources to deliver on short-term requirements for change.

Health Secretary Alan Milburn unveiled plans to allow private sector managers to run failing NHS hospitals and give successful units autonomy over their own affairs last month.

His proposals provoked a mixed response from health workers' representatives.

Mr Milburn has announced reforms

Mr Milburn has described the proposals as a fundamental reform of the NHS, but critics say they are a kneejerk response to negative media coverage about the state of the health service.

If the RSA report is accurate then his apparent desire to decentralise decision-making is in stark contrast to the trend since Labour gained power nearly five years ago.

The report also highlights the difficulties in recruiting NHS board members in part because of the number of hours they were required to put in - described as the "biggest deterrent in recruitment".

At the same time, however, the survey found little evidence of political favours in board appointments.

Huge effort for change

The report suggests that the present system of "corporate governance" would hamper the "pace and energy" needed to fulfil the government's ambitions in relation to public service improvements.

Mr FitzGerald said: "To achieve meaningful change at the national level requires a huge effort.

"This project is about the delivery of change without a vast financial expenditure or unreasonably long time-scales.

"It is not just a question of service levels; real accountabilities rest on more reliable information, new ways of measuring performance, and the right amalgam of people if effectiveness is to be linked with efficiency."