Sovereign remedy

Niall Dickson
Niall Dickson: finalising work on a new constitution, revising the 1907 act that established the fund.

God save the King's Fund, the independent thinktank specialising in healthcare that is about to celebrate its 100th birthday with a burst of modernising zeal. The fund has long been regarded as a national treasure. Thanks to an endowment raised by public subscription at the beginning of the last century, it has not been beholden to any of the warring interest groups that tried to shape the NHS through nearly 60 years of permanent revolution.

Patients and the public have come to trust its research and analysis. Politicians think they gain kudos from associating with it. The fund is able to go where politicians fear to tread. It commissioned the inquiry into adult social services which found that spending on personal care for older people in England would have to treble to some £30bn a year by 2026 to meet the needs of an ageing generation.

So if the fund is not broke - morally or financially - what are the problems that its modernisers are trying to fix? The chief executive is Niall Dickson, former social affairs editor of the BBC. He is finalising work on a new constitution, revising the fusty language of the 1907 act that established the "King Edward's hospital fund for London". After going through the hoops of getting Charity Commission approval for restating the fund's objectives, Dickson is optimistic that the palace will soon confirm a new royal charter.

The language of the original act was splendidly arcane. It stipulated that the fund's president should be "some person being a son, brother or grandson of the sovereign". It instructed the lord chancellor, prime minister and governor of the Bank of England to decide which of these male royals to recommend. That is presumably how the current incumbent, Prince Charles, got the job as the fund's titular head.

The act also specified that the fund should be London focused - a requirement it has escaped by assuming that its national work brought indirect benefit to the capital. Dickson says the new constitution is "a once in a lifetime opportunity to get it right". The fund will retain a focus on London, but be empowered to operate nationally. Like other charities, it will set up a trading arm, allowing it to embark on money-making projects. The finances have recovered from "a rocky patch" in 2001 when a collapse in the stock market reduced its asset base to about £100m. There is now some £135m in the fund, but Dickson says he is "passionate about being prudent". He wants to earn more and draw less from the endowment income.

"The endowment is a guarantee of independence, enabling us to criticise the government or any other vested interest. It gives us freedom, but on top of that we have to generate income through our activities. We see ourselves as an organisation that provides services, often in competition with others."

Dickson has plans for a 200-seat auditorium at its headquarters in Cavendish Square, central London, and he is looking to give the fund a membership arm. This would attract subscriptions from people with an interest in healthcare, who would be able to meet and study in a members' area, with access to information from the fund's library. He wants membership to extend beyond the senior levels of the NHS to "people on the frontline who are interested in innovation and change". He insists that the fund would not be in competition with the NHS Confederation. "I will be providing a set of services to people, not trying to represent them," he adds.

Dickson wants the fund to become "the thinktank that does". It is no longer enough to issue weighty reports and retire to the ivory tower. The fund should be prepared to work with organisations in the field to put ideas into practice. "Testing ideas and finding they don't work is a perfectly valid thing to do," he says.

The fund already has a partnership with New York University and Health Dialog, a US data analytics company, to develop a programme to identify patients most at risk of emergency admission to hospital. It is being used, free of charge, by 70% of primary care trusts to provide extra healthcare support for the most vulnerable.

So far, so benevolent. But could the fund's independence become compromised by such corporate links? Might its analysis be tainted if it moved into promoting its own development projects in competition with others? The fund already has partnerships with Marie Curie, the cancer care charity, Microsoft, and Ernst & Young, the business services corporation. It raised eyebrows in June by signing a tie-up with Humana, the Kentucky-based healthcare giant that was pilloried by Michael Moore in Sicko, a documentary-style movie that targeted the US healthcare industry. Humana may have gained credibility as it tries to win contracts to improve NHS commissioning in England, but was the £30,000 it contributed to the partnership an unalloyed benefit for the King's Fund?

Dickson is unrepentant: "They are miles ahead in understanding about how you can gear healthcare systems to keep people well rather than responding when they are ill ... We don't compromise our objectives or ability to comment on the healthcare system. We are not so in hock to anybody that we can't end the partnership if there was reason to do that."


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