Doctors resent political interference

Under the plans, the board would take day-to-day control of the health service, leaving ministers to set budgets and strategic direction.

Professor Julian Le Grand, a former health adviser to Tony Blair and now the Professor of Social Policy at the London School of Economics, gives his view on the plans.

"Almost anything that would insulate ministers from having to stand up in the House of Commons and defend everything that goes on in the NHS is a good idea.

There is a case for having ministers dealing with the strategic objectives, and leaving the day-by-day operations to someone else Professor Julian Le Grand

"The NHS is absolutely huge. By 2008 it will be consuming something like 0.3% of the GDP of the entire planet, and the idea that one person, however able they are, can actually deal with all the minutiae that go on in the NHS, absolutely everything from a bed pan dropping off a bed to a cancelled operation, is frankly absurd.

"There is a case for having ministers dealing with the strategic objectives, and leaving the day-by-day operations to someone else.

"But the parallel with the BBC is an interesting one. The BBC works for one rather good reason - it is a kind of independent corporation, but it is operating in a ferociously competitive market.

"If you hand over the control of the NHS to this independent board, there is a danger that you are going to create not so much a BBC, operating competively, and responsive to the needs and wants of the people who are listening to it, or watching its programmes, but something more like one of the old nationalised industries, which was not an efficient and effective way of running a service."

Interest rates

Mr Brown's proposals have been compared to his widely praised decision on his first day in office to give the Bank of England independence to set interest rates.

However, Professor Le Grand said people should be careful before drawing comparisions too closely.

He said: "The Bank of England independence was about making one decision about just one number: interest rates.

"It is a very complex decision, but it is very different from actually providing a day-by-day service, which is what the NHS does, with millions of people being involved in its activities every day.

"And again the Bank of England is not exactly providing a service in a competitive environment, so we have got to be a little careful about drawing that parallel.

Historical parallel

"One of the ironies is that in some ways we are going back to the old idea behind the NHS originally.

"In 1948 the idea was that the politicians would set the budget, and the people who worked in the NHS - at that time thought to be only doctors - would run it.

"In practice both sides let down their side of the bargain. The doctors started challenging the politicians to provide more money, and the politicians said if we are going to provide more money, we have got to have some say in how that money is spent.

"That is a tension that I think will still be present in whatever system we devise."