When things go wrong in a David Cameron and Andrew Lansley-led health service, who will carry the can?

Under David Cameron’s blueprint released yesterday, day-to-day responsibility will be removed from ministers and handed to a council of doctors and managers known as the NHS board. Elected Tory politicians will set “strategic objectives”, but it will be for this body, effectively a super-quango, to oversee its £100 billion budget and execute its powers in whatever way it sees fit.

To emphasise this shift, Tories will change the title of Health Secretary into Public Health Secretary — responsible for improving health service outcomes rather than every last element of its execution.

But what happens when the NHS faces a crisis, such as the one in Staffordshire, when about 400 patients died needlessly because of deficiencies in emergency care?

According to one shadow Cabinet member, accountability under a Tory government would work very differently.

“We want to challenge and change the media narrative — we are not responsible for every bedpan in every hospital. Just like there isn’t a postmaster general responsible for the installation of phone lines, as there was in the 1980s, the consequence of devolving decision making is that others have to be accountable.”

The idea, Tories say, is to stop political reorganisations of the NHS and give doctors more certainty. “Yes, we do want to give more power to professionals. Much more power — and we think that’s a very good thing,” Mr Cameron told the Royal College of Pathologists yesterday.

But the history of passing responsibility from ministers to “independent bodies” is a chequered one.

One of the most successful was the 1997 decision by Gordon Brown to hand responsibility for interest rate decisions to the Bank of England. Today few oppose that move, seen as a brave and defining decision in the early days of the new Labour Government.

But cynics point out that the public accepted an independent Bank of England because interest rate decisions were, initially, largely uncontroversial. Had each monthly verdict been a battle between mortgage holders’ interests and the need for financial stability, it might have been very different.

Government-by-quango can go very wrong. Earlier this year it emerged that the Learning and Skills Council wasted hundreds of millions of pounds through “catastrophic mismanagement” of a flagship college building programme. Ministers appeared more than happy to let them carry the can, avoiding any responsibility themselves. Such a move would not be possible with the health service.

Experts are perplexed at the overall Tory approach. While George Osborne threatens to slash most quango budgets, reduce staff and clip their powers, Mr Lansley appears to be going in the opposite direction.

Niall Dixon, chief executive of the King’s Fund, the healthcare think tank, argues that politicians are unlikely to be able to properly transfer responsibility. “I can’t see how, in a system where we’re spending £100 billion plus of public money, politicians could distance themselves from decisions,” he says.

Mr Cameron’s speech contains inherent contradictions in the way the party wants both to control the NHS and let it run itself — calling for the NHS to run itself while also also calling for a moratorium of hospital closures which are decided locally by NHS trusts themselves.

The Tories say that in the event of a Staffordshire-style disaster, however, the Secretary of State will still, ultimately, be responsible to Parliament. The NHS board, they insist, will report to him. But will the new Secretary of State really be content to justify decisions he hasn’t taken? Or will the board members become high-profile figures who will take to the airwaves to defend such decisions?

In September 2006, Gordon Brown said he was considering the same plan — for an independent board to run the NHS — ministers’ roles would be limited to setting the NHS budget and strategic objectives. By the time Alan Johnson became Mr Brown’s first Health Secretary, this had been abandoned because it was judged politically impossible.

Whether a future Tory government is ever truly able to “devolve” power is yet to be seen.

Times Recommends

• Postmen: We bind the nation together
• Tewkesbury: when the memories flood back
• Cast Offs actress: I’m happy that my face fits