This morning, I had one of my regular informal meetings with local senior NHS management. As you would expect, the present top-level political manoeuvring leaves senior NHS staff in a difficult position: how can they plan when policy is again up in the air?
Right now, the NHS is scarcely under democratic control. Whether it should be is another subject but the fact is that health is primarily state provided in the UK. You would expect the state to have a grip.
However, not only is the NHS out of democratic control, it is scarcely under Departmental control either. Before my election, I had cause to meet a number of the most senior Department of Health officials and the overwhelming majority began the conversation with, “This is not NHS HQ.” In then discussing how the NHS is organised, I quickly found that the structures are astonishingly complex and that senior staff get things done through informal channels.
So, here we have the world’s second largest employer, funded by taxation, and not in any meaningful sense answerable to the people who pay for it. Even Tesco answers to the people: we could choose not to shop there.
If that seems far-fetched, so is the notion that the NHS is under meaningful public control. That is what the Government’s reforms were about: getting healthcare under control by pulling the one available lever – structural reform.
And yet here we are: the Lib Dems seem to be threatening to veto changes which are, as John Redwood explained on the Today programme this morning, very much in line with the Lib Dem manifesto. We know why the conversation has taken this turn: their party and their leader just took a pounding. But Clegg signed the health whitepaper. He was fully behind these reforms but now there’s turmoil.
Why should the public or NHS staff tolerate these shenanigans? Health care is too important to be subject to politics like this. Whatever emerges from the present pantomime, reform should shift the balance of power from politicians and unaccountable officials to the public.
Only the public have the capacity and the will to ensure health services meet their needs and expectations. We should take the politics out of health.