When Andrew Lansley was appointed to the cabinet by David Cameron in May 2010 you might have expected the new health secretary to take the trouble to introduce himself to the leading players in his department. But no - his first meeting with Sir Roger Boyle, who had been toiling away as the Government’s National Director for Heart Disease and Stroke for more than a decade, did not come until a couple of weeks ago, for what Boyle describes as a “decapitation.”
The heart czar had given a speech in which he described Lansley’s claim that the NHS was over managed as “complete baloney”. He had critcised the NHS reform strategy of throwing out the old and bringing in the new “without even looking at things that have worked well,” and had warned about the dangers of dismantling relationships nurtured over years and destroying “corporate memory.”
A day or two later he appeared on the Today programme to re-iterate his criticisms, expressing the widely held view that what the NHS needs now is “stability not more change.”
Lansley was not pleased. Boyle described what happened. “Miraculously, I found myself in his office. His aides were debating whether they could sack me before they discovered I was going anyway. Lansley said he was disappointed I had gone public without telling him. Which is fair dos except he could have found out if he had bothered to see me. It was a short meeting. I had my knuckles rapped.”
It is a pity Lansley had not made more effort to find out what Boyle was up to because he would have learnt some important lessons about the NHS and what it had achieved without the benefit of the market revolution being ushered in under the NHS reforms.
During his 11 years in post - Boyle retired on Friday - the death rate from heart disease has halved. Waiting times for treatment have been slashed. There are more surgeons, more patients on drugs (for blood pressure and cholesterol), better equipped units,and around 60,000 lives saved each year - half from changes in lifestyle (such as reduced smoking) and half from improvements in treatment. Not a bad record on which to bow out.
The scale of the advance has been so great that the NHS has had to cut back on training posts for heart surgeons because there will not be enough work for them to do in the future. As well as improved health, the NHS is starting to save money.
But Lansley was not keen to trumpet this success. And Boyle thinks he knows why - it does not play to the Health Secretary’s agenda which is to dismiss everything done before his time in order to bolster support for the revolution he has meticulously planned to open up the NHS market and subject it to more competition.
“Competion means more providers, which means more contracts have to be placed which means transactional costs rise. The allegiances [of the private companies] will be to their shareolders not to the users of the services. We have already spent £1billion on redundancy payments. Is that value for money?”
“If the market was going to work the Americans would have cracked it. My 91 year old American mother in law (who lives in Florida) has to fill in a 150 page form each year for her health insurance and then more forms each time she makes a claim."
“I favour evolution, not revolution.We could have got to the same point without this huge disruption. Everything has effectively stopped [while the reforms are thrashed out] except the focus on saving cash - it is very unsettling.”
Boyle acknowledges that Lansley has an “encyclopaedic knowledge” of the NHS, honed during his six years as opposition health spokesman. “But I don’t think he has got it right. You cannot take a huge organisation like this and get buy in [to the reforms]. Alan Milburn [Labour’s former health secretary] did extensive workshops with all the interest groups which gave him moral authority to implement the NHS PLan in 2000. Even the Thatcher reforms [of 1989-91] took three years from white paper to the bill. Just getting a group of advisers together isn’t enough if you are going to do something as radical as this.”
He is not encouraged by the reformed reforms produced by the NHS Future Forum, following the “pause”. Lansley’s plan felt like “the ideas of one man acting without an electoral mandate,” and still does so.
“They appointed people [to the Future Forum] they knew would give them the answer they wanted. Even the reformed reforms will deliver about 80 per cent of what Lansley wanted. ”
Boyle was one of the first czars to be created and only Mike Richards, the cancer czar, has outlasted him. He avoided rocking the boat - almost to the end - preferring to keep the counsel of close colleagues. But his views are known to be widely shared within the department and the profession.
“All the improvements in cardiovascular care have come from collaboration and leadership. Where is the evidence that competiton between commercial providers makes a blind bit of difference to cost efficiency and quality? The competition I want to see is between clinicians vying with each other over whose service is the best. If you try and improve care by getting United Health to provide the service that would be crazy.”
“I absolutely think the NHS is the best public service in the world. It is horrific that its future is threatened.”
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