Harold Wilson once famously said that a week is a long time in politics.
Apparently the current Secretary of State for Health is quite chipper as he goes about his work at the moment. Looking forward to implementing his Act and paying no attention at all to the very deep mess into which he plunged the Government and the NHS only 10 weeks ago. For him these have been 10 weeks during which apparently everyone has forgotten that he was about to finish off the NHS.
Of course he has been lucky. Twenty months of what appeared to be incomparable ineptitude in his handling of NHS reform has been forgotten. This is because the Government’s chief strategist and safest pair of hands, George Osborne, has created a new word in British politics with his budget – an omnishambles.
Twenty months of failed NHS politics has been obliterated by just ten weeks of failed politics on the economy. Andrew Lansley now just looks normal rather than a disaster.
Last Sunday he appeared on the Andrew Marr programme outlining how GPs should use new media to contact their patients. Very modern methods of delivering health care – something that in my opinion would improve the NHS immeasurably.
But later in the day I began to reflect on why the Secretary of State was on TV arguing for these changes in primary care when he had come to power promising no political micro-management of the health service. Getting my GP to email me looks to me like a really good idea. But the Secretary of State saying it should happen looks a lot like political micro-management.
So I thought I would glance at the information strategy that was published on Monday, of which the increased email traffic between myself and my GP forms a part.
The information strategy suggests all sorts of good outcomes that will improve communication both within the NHS and between it and the public. But the fact that it is being launched by the Secretary of State brings us back to the major political problem for which Andrew Lansley’s tenure of office will be remembered.
If he believes that he should not be responsible for the NHS, What is he for?
Famously his Bill was so transformed from this original intention that in fact he is now very responsible for the NHS. But he doesn’t want to be in charge…
If that is still the case why was he on television talking about the NHS information strategy? He could quite simply have said that this was not a matter for the DH and left it to David Nicholson or someone else from the NCB.
So he is clearly in charge of a publishing a strategy which, in much of its detail, pretends that he is not in charge. But he is.
The Secretary of State’s Act has created two new national bodies to be in charge of national actions – the National Commissioning Board and Public Health England. The Secretary of State – through the Department of Health – asks these two bodies to look after the ‘N’ in the NHS.
However in the end the Act still retained the role of the Secretary of State – and therefore the Department of Health – whilst additionally creating these new national bodies.
In the final section of the strategy, “Making it happen” section 6.16 it states,
“At the national level, the NHS Commissioning Board, Public Health England and other bodies, together with the Department of Health, will wish to consider more detailed implementation plans to achieve this vision”
So there you have it. In the end the new national bodies which were meant to be in charge – are not in charge. They are up there alongside the DH.
What this means in practice is that the DH, NCB and Public Health England all form a committee of information officers to implement the Act.
And clearly from the Secretary of State actions on the Marr programme last Sunday, he will be in charge of it (whilst continuing to pretend that he isn’t).