Yesterday, up in Manchester for the Labour conference, I found a secluded spot and asked a close friend for an explanation. He gave me a pitying look and told me that a manse was a sort of Scottish vicarage.

Oh. But how can a vicarage have a son? Oh well, never mind.

It would be fine if this manse business was the only thing to produce knowing nods by everyone else and a bewildered shake of the head by me. But it isn’t. For the past couple of days I’ve been wondering what it is that the rest of the world sees in Mr Brown’s NHS reform that I’ve missed. Those people who don’t confidently reply “son of the manse” when asked about Mr Brown instead say “man of substance” and cite his NHS reform plan as evidence of his sagacity. And there am I thinking that it is completely daft.

The policy of giving the Bank of England the power to set interest rates, free from political interference, has been an undoubted success. So now Mr Brown wants to extend that model to the public services, with the NHS most commonly named as the first to be reformed in this way. An independent board will be established to administer the service, with the role of politicians restricted to setting overall goals and strategy.

Conservatives are sufficiently enthusiastic about the idea to claim that Mr Brown has stolen it from them. The day will come when the Tories will pretend that they had nothing whatsoever to do with it.

From the years when I used to write politician’s speeches for a living, I know the two hardest things. The first is writing jokes. I remember sitting up at two in the morning reviewing a list of gags that had been sent in by Ken Dodd, not one of which was even remotely amusing.

The second difficult task is identifying a couple of good specific policy ideas to give to the media so that they don’t dismiss your big themes as so much hot air. In the political satire The Thick of It, the adviser Glenn comes up with the idea of making everyone carry a plastic bag just so his minister could announce something that wouldn’t cost much. This wouldn’t have seemed out of place in some of the discussions I’ ve been in.

The problem with the policy ideas is that you either discover that someone has done them already or that it was such a flawed notion that no one would want to do it. Well, congratulations to Mr Brown. His big speech idea ticks both of these boxes.

The NHS is not like the Bank of England. The Bank is setting the price of money. The NHS has an output not far off that of Portugal. It handles something like 10 per cent of our national income. It employs thousands and thousands of people. It is a very different animal.

There are two ways of holding such a body to account. The first is through voice — the right to protest to a political representative who depends on your vote. The alternative is exit — the right to take your custom elsewhere, with the seller dependent on your patronage in order to thrive.

Mr Brown plans to remove both these forms of accountability. When he describes the new board as independent, you just have to ask: independent of what, exactly? And the answer, it turns out, is independent of you and me.

Sir Peter Lachmann, former president of the Royal College of Pathologists, felt moved to write to this newspaper that Mr Brown’s new policy was “probably the best news the NHS has had in the past 30 years”. I was not surprised to read this endorsement. The senior management of the service is bound to conclude that the interference of meddling politicians is nothing but a nuisance. They want to run their NHS with our money and without us pesky voters sticking our nose in the whole time.

The Chancellor is arguing that the closure of a local hospital ought to be decided by health service managers without the right of politicians to prevent it. If he isn’t saying this, he is saying nothing. But is it really acceptable that such sensitive decisions be made only by a group of unelected people, accountable only to each other and without appeal to the local electorate? The model that Mr Brown intends to apply to the NHS is not really the Bank of England at all. It is, well, the model that the Tories tried to apply to the NHS in the mid-1980s.

In 1985 Norman Fowler, then the Health Secretary, appointed Victor Page as the chief executive of the NHS with the idea of relinquishing political control of administrative matters. It was perhaps with this experience in mind that another former Health Secretary yesterday told me that he thought Mr Brown’s plan was “bonkers”. Political pressure from voters and the media ensured that it didn’t last five minutes. And neither will Mr Brown’s plan.

There is an alternative. If Mr Brown truly wants to stop political interference in the day-to-day decisions made by clinical staff and local management there is something he can do. He can replace accountability by voice with accountability by exit.

If a local hospital were to close because everyone was using a better service near by it might anger some residents. But no one could claim that the service providers were unaccountable.

The Chancellor has set his face against such a Blairite (actually Tory) solution. But his third way between two forms of accountability is to provide no accountability of all. His NHS board idea was intended to reinforce his image as a man of substance. I think he would have been better off with one of Doddy’s wisecracks.

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