Health Matters | Paul Corrigan's blog

Conservative policy documents for several years leading up to the election had pledged to “remove politics from the day-to-day running of the NHS” and to “end political micro-management”

This language was repeated in the Manifesto and has been repeated since then in both speeches and in the White Paper itself.

I labour this point because something that is repeated by political parties over and over again has a resonance with what they believe in and what they want to do. So the drive by Conservatives to ‘keep politics out of the NHS’ goes beyond an ephemeral policy of the moment and is something that matters to them.

Taking them at their word I believe that at a level of ideology they are genuine in this aim. They probably genuinely believe that a set of ideas called ‘politics’ and a set of practices called ‘medicine’ should not come together. So now they have power they want to make sure that politics does not try and run medicine.

My problem is not why they are doing it – it makes sense to them and they won a lot of votes on that Manifesto. My problem is not having thought about it for a long time, and then having become a Government, not why they do something they believe in, but why they do the reverse.

What are the pressures on a new Secretary of State for Health that do not allow him to carry out a Manifesto pledge? Why does the current Secretary of State find himself developing and in some cases entrenching his political power, rather than getting rid of it as he believes.

The answer comes from party politics as a set of day-to-day practices, and not necessarily the ideas that were in the Manifesto.

I think there are three main day-to-day pressures from parts of the Conservative Party which have and will force the current Secretary of State to introduce more Conservative party politics into the day-to-day running of the NHS.

• First, spending £110 billion pounds of public money raised by taxation demands political accountability.
• Second, the public that elected their MP demand accountability through their MP
• Third, the Conservative Party on the ground demands political interventions in the NHS

Spending £110 billion pounds of public money raised by taxation demands political accountability.

It sounds good to say that the Conservative Party wants to ‘liberate the NHS’, but in practice the NHS spends £110 billion of taxpayers’ money. The Conservative Party is a party of low taxes and, as far as possible, tight public money. Whilst it was elected on a policy of slightly improving the resource amount of the NHS, it was also elected on a policy of looking at how public services spend every penny.

The future of the Government – and definitely winning the next election – depends upon its political control of public expenditure. This control is direct and will be assisted by the historic role of the Treasury. The Conservative Party in the country will be making sure that its Government knows all about waste and inefficiency and it will expect its Government to stop it.

We have already seen the Government bring its plans on GP commissioning into direct control by the state by making GPs join statutory organisations. Over the next few months, as the political control over public expenditure in other areas tighten, we can expect to see the same happen with other aspects of the NHS. For example I would not be surprised if the current Secretary of State for Health tries to intervene in setting salary levels of chief executives and their directors.

Party political control does not get more day-to-day than setting pay scales for the senior managers of every NHS organisation. Certainly if he doesn’t the Daily Mail will be raising the fact that it expects its government to control every penny of public money.

Conservative party politics will demand interventions in the day-to-day expenditure of their money.

The public that elected their MP demand accountability through their MP

Every Friday evening and Saturday morning representative democracy brings voters and MPs together in surgeries. It’s one of the cornerstones of our democracy and it means that by Monday morning MPs return to Westminster with a list of things their constituents want sorting out.

In most parts of the country the NHS is within the top three of issues that the public expect their MPs to sort out. Conservative MPs are no different from others – except that more of them are very new – and therefore think hard about the next election which might send them back to where they were before May this year.

This means that they all leave their constituencies with a set of promises to sort things out with the NHS. Some of this is sorted locally but a lot of it is dealt with by the phrase “I will raise this with the Secretary of State”.

This is done by letter and, if you are Conservative MP, it will be done by informal or formal meeting in the House of Commons. MPs ‘raising the issue with the Secretary of State’ is a part of public expectation.

Sometimes this is raised even more formally through a written question to the Secretary of State on the House of Commons order paper. There are more written questions about the NHS than about anything else.

The White Paper seems to want to stop this by making most of these issues the role of the National Commissioning Board. As the Health Bill goes through Parliament MPs will be confronted with the opportunity to vote away the expectation from their constituents that they can raise NHS matters with the Secretary of State.

This clash between Government ideas about policy and Government MPs practice of party politics will be an interesting one, but at base I don’t think the English public want their MPs to have no role in intervening in the day-to-day running of the NHS.

The public rightly think it is their money, voted by their MP, and they should be able to use that route for accountability.

The Conservative Party on the ground demands political interventions in the NHS

There are two major areas of politics where the Conservative Party demands greater party political micro-management and where the current Secretary of State has agreed.

The first is changes to the configuration of hospitals. The Conservative Party demanded before the election that their Secretary of State is in charge of these reconfigurations and that he makes the decisions over major hospital changes.

From day one the current Secretary of State has readily agreed. Personally stopping the previous Secretary of State’s practice of always agreeing with the Independent Reconfiguration Panel’s recommendation and making it clear that he will override these for party political reasons . And in the White Paper making it clear that the final arbitration of hospital reconfigurations will be up to him alone.

The current Secretary of State has insisted the hospital closures are essentially party political and rather than remove party politics from that he is entrenching it through his own actions.

He is supplementing that through the power of the Conservative Party in the country.

The Conservative Party in the country is very strong in local government. (For those who have never been in one of the three main political parties it will come as a surprise to them that there are whole tranches of each of those parties who fundamentally believe that local government is much more important than Parliament. They believe this because many many more of the people who actually run and do all the work in the Party are councillors and only a few are MPs. What matters in the day-to-day practice of party politics is Local Government.)

The Conservative Party on the ground believes that party political local government should have a much greater say in running the NHS. The White Paper concedes this ground to them. It recognises that it cannot give commissioning to local government because if that was the case the GPs would not be involved – so it gives local party politics controls over nearly everything else.

This means that an army of party politicians – not just a single Secretary of State – will be micro-managing the NHS and why? – Because the Conservative Party wants it so.

A second area of political micro-management is even more telling. For the last decade the appointment of many non-executive directors in the NHS has been through an independent organisation called the Appointments Commission. Political parties on the ground have many local people with expertise that they feel should be running all sorts of institutions.

The Appointments Commission is almost universally disliked by MPs in Parliament because so many local people from all of the political parties have not been appointed by the Appointments Commission. And when they don’t get appointed they complain to their MP.

So for the last few years the current Secretary of State has been bombarded by disappointed local Conservative political parties about why Councillor x or y – who is an excellent person – was not appointed by this awful Commission.

Over that period of time the current Secretary of State decided that the Appointments Commission would be abolished and he would appoint all of the new non execs.

It is this pressure that ends up in very odd situation where a White Paper that is committed to stopping the party political micro-management of the NHS will provide the political Secretary of State with the right to approve every non-executive director of the NHS.

Why has he done this?

The answer is that he is politicising the reconfiguration of the NHS hospitals and the appointment of non-exec directors is something that the Conservative party wanted and the Secretary of State has not said ‘no’ to.

This means that from now on every change, in every hospital,will be party political.

Every appointment to every NHS board will be party political.

That means that if the opposition has any sense every health question time in Parliament will politically contest every one of his political decisions.

It is in this way that the practice of Conservative Party politics triumphs over the ideas in their Manifestos.