Politicians are often accused of treating the National Health Service as a political football, insisting on initiative after initiative, to prove that there really is action this day, and yet they consistently fail to plan for the long term. They seem to think that structural reform and targets will yield results – and sometimes, in the short term, they do. But who can really say that they can think of a single health secretary – of either party – who has planned for the long term?
During its 13 years in power, from 1997 to 2010, the Labour government had six health secretaries. The Conservatives under Margaret Thatcher and John Major did a little better and managed only seven in 18 years. The coalition has had two health secretaries. The post is held for an average of a little more than two years.
So, they spend six months reading themselves into the job and the last six months trying to save themselves from being sacked. This gives them each just a year to make an impact.
Bearing in mind that the NHS is one of the world’s largest organisations, this way of running it is utter madness. If IBM or Glaxo changed their chief executive every two years, their share prices would plummet and within a short time the company would be considered a basket case. And so we constantly hear pleas to take the politics out of the NHS. Liam Fox, when he was the Tory shadow health secretary, said it. Various Labour ministers have said it. Andrew Lansley said it. Jeremy Hunt actually believes it. But surely none of them can be so naive? Well, it seems that the general public agree with them.
A poll for the British Medical Association conducted by Ipsos Mori found that two-thirds of the general public wanted the NHS to manage itself without the involvement of politicians. Another 46 per cent also said politicians should have low or no involvement in how the NHS is run.
They are all wrong.
We have to have democratic accountability in the NHS. After all, the fact that the Health Service eats up £115bn – one-sixth of public expenditure – means that the way that money is spent has to be made accountable, and that has to be through the political system.
Any politician who calls for politics to be taken out of the NHS is likely to be doing it to get a cheap round of applause on Question Time and can safely be ignored. It isn’t going to happen, and nor should it. Interestingly, that free-market think-tank, the Adam Smith Institute (ASI), begs to differ.
It proposes that a distinguished panel of health professionals be appointed to run the NHS, to allocate its budget, determine its priorities, and operate it according to medical needs rather than political aims.
A YouGov poll taken on the subject showed massive popular support for precisely such a proposal, with 69 per cent in favour and only 12 per cent against. The NHS budget would be set by Parliament every five years, and increased each year in line with inflation. The ASI’s YouGov poll showed that this idea, too, enjoys widespread popular support, with 74 per cent in favour. The suggestion that “the NHS has become a political football” receives 72 per cent backing.
Whatever the merits of the ASI’s proposals or those of the Conservatives, an independent NHS certainly isn’t going to happen when we have such “consummate” political brains within No 10.
Think back to the Gordon Brown government. I’m told that the “deep clean” initiative wasn’t thought up in the Department of Health. It came directly from the No 10 Policy Unit, which gave the department a few hours in which to consider how to make it work. It was duly announced by Mr Brown, who made it sound as if this would be the only measure needed to eradicate MRSA and Clostridium difficile from our hospitals. Indeed, when I heard about it, I too thought it sounded a rather sensible measure. That is, until I switched on a radio phone-in and heard a succession of health service professionals slam it. Not a single one of them thought it would work. It was at that point that I started to wonder whether this gargantuan political brain was actually as formidable as we’d all been led to believe.
Just as a transport secretary is judged on whether their tenure of office is free of a major rail crash or transport disaster, a health secretary is now judged on whether he or she can keep NHS stories off the front pages. That’s why Mr Lansley had to go, and was replaced by a politician with a far better bedside manner.
You simply can’t take politics out of the NHS, and nor should you. We ought to be having a big debate about the NHS, but we are being denied that debate because whenever any politician on the right or left, but mainly the right, has the temerity to criticise the NHS, he or she is jumped on and warned about the consequences of having a go at a beloved institution.
If you point out that outcomes in the NHS are, in most areas, way below other comparable nations, you are accused of denigrating people who work so hard in the NHS or advocating privatisation, even when you’re not. If the NHS can’t stand up to a robust critique, it says an awful lot about the arguments of its very vocal defenders.
'The NHS: Things That Need to be Said', by Iain Dale, is published tomorrow by LBC Books at £8.99 in hardback
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