Senior healthcare experts today criticised government NHS reforms as incoherent and called for a national review of the way the health service is governed and managed.
But in a series of articles in the British Medical Journal, they rejected a call by its editor to make the NHS independent of ministerial control, warning that such an agency could be highly bureaucratic and unaccountable to the public.
Professors Donald Berwick and Sheila Leatherman, Americans who describe themselves as "unabashed fans" of the NHS, warn that "the failure to capitalise fully" on extra investment, together with the billion-pound debts of health trusts, makes even the government's best reforms "increasingly vulnerable".
They write in the BMJ: "The panoply of changes, the sudden policy corrections, and the impatience that makes plans end before gaining traction, create confusion and cynicism for even a willing workforce. If the NHS was a publicly traded company, stockholders would flee because of its unsteadiness of course."
The BMJ editor, Fiona Godlee, proposed in April that the NHS be turned into an independent authority, run in a similar fashion to the BBC, to protect it from the whims of party politics and "halt the rapid turnaround in policies that seem to be destabilising the system".
Dr Stephen Gillam, a Liverpool GP, writes in the journal that the government is "flip-flopping" with its health reforms, accusing ministers of using structural reform to divert attention from NHS debts.
But the GP believes that making the NHS an independent authority would hasten the privatisation of the health service. He says such a body would be reduced to commissioning competing professionals, health trusts and private companies to provide care.
Gwyn Bevan, professor of management science at the London School of Economics, criticised the government's imposition of political targets. He writes in the BMJ that the system fails to take account of local circumstances, unfairly penalising some health trusts.
The professor contends that the NHS should be reformed to make it more accountable to the local communities it serves. His view is shared by Stephen Thornton, director of the Health Foundation thinktank, who warns that an independent NHS could be an unaccountable quango in whose running, patients would have little input.
Mr Thornton suggests devolving control of the NHS to either elected regional assemblies or local councils, which he says would allow for much greater public scrutiny.
Fiona Godlee told Guardian Unlimited that she realised her proposal to turn the NHS into an independent authority was "perhaps rather naive". But the editor said she had been motivated to spur debate due to widespread unease with the pace of government reform.
She said: "Nick Timmins [public policy editor of the Financial Times] said it was hard to write about the NHS because it was changing so fast. And people working in the health service feel exhausted by the amount of change."
Ms Godlee said she would like to see a panel of experts come together to brainstorm alternative forms of NHS governance, which could protect it from "extreme political involvement".
A Department of Health spokeswoman said the experts appeared to have "fundamentally misunderstood" its reforms of the NHS. She said funding and power were increasingly being devolved from central control.
She added: "Reforms are not inconsistent. We know change isn't easy but patients want better, faster services and the reforms are designed to achieve that. We need to go even further if we're to make the NHS truly responsive."
