The Health Secretary, Andrew Lansley, has made no secret that the voluntary sector will be at the heart of the Government's plans to reform the NHS, forming part of an overarching strategy to decentralise decision making. Underlying this is the need to achieve costs savings and we have already seen the beginnings of what this will mean with the July review of the Department's 18 "arm's length bodies" resulting in the conclusion that six should be abolished, including the Appointments Commission. Many NHS charities will also be affected by the pending demise of PCTs and the uncertainty this will create. Elsewhere, we have seen the Local Government Secretary, Eric Pickles, resolve to abolish the Audit Commission by 2012 with the future of its NHS audit function for NHS left to be dealt with as part of a wider reform of the NHS.
This strategy reflects the Government's "Big Society" ambition to redraw the lines which divide business, the civil society and the State. The architects of the Big Society tell us the State is not (and never has been) the best instrument to address social problems; social enterprise organisations, encompassing charities, are therefore being challenged to fill the space previously occupied by public bodies and to alter expectations about what local and central government should provide. Whilst no-one can tell us at this stage precisely what Big Society will look like, we do know that it will be the opposite of "big government". The State will endeavour to catalyse the delivery of services by social enterprises at a local level with minimum interference and to cut red tape. In this connection, the Office for Civil Society announced the formation of the Big Society Deregulation Taskforce, to be led by Lord Hodgson; it will make recommendations about how red tape should be reduced, including changes to legislation or processes that are needed.
Against this political backdrop it would seem that the door is now ajar for NHS charities to engage with the Department of Health regarding the regulatory landscape in which they operate. Whilst NHS charities fall within the jurisdiction of the Charity Commission and have not been required to submit accounts to the Department of Health since April 2005, it remains the case that the Secretary of State for Health's power to appoint trustees of NHS charities coupled with an overarching power to claim charitable funds for the NHS, mean that the State retains significant, albeit indirect, control over the application of these funds. Given that in, some cases, the source of those funds derives from philanthropy which predates the NHS, this degree of State control would appear somewhat at odds with the theme of Big Society.
Perhaps more fundamentally, at a time of limited public finances, the taxpayer is entitled to question why there is a need for the Department of Health to assume a quasi charity regulatory role when an expert independent regulator already exists in the form of the Charity Commission. With many NHS charities already directly governed by NHS bodies and with the shadow of IAS 27 looming in the background, it is perhaps more appropriate than ever, in terms of promoting independence in this niche sector, for the regulatory function to be provided by an independent body and for the umbilical cord with central government to be severed.