Safe in whose hands?
Last weekend it was widely reported that Gordon Brown was considering establishing an independent board to run the NHS — if he ever becomes Prime Minister. Mr Brown has a track record in advocating such an arrangement. The first decision he made after the 1997 Labour Government
came to power was to hand over control of interest rates to the Bank
of England. It has been thought to have contributed to the stability
of the UK economy over the past decade.
Under Mr Brown’s plans for a devolved NHS board, ministers would
be kept at arm’s length, their role limited to setting the NHS
budget and strategic objectives.
So would such a model work for the NHS? In theory, the answer should
be “yes”; in practice, probably “no”.
Running the NHS is rather more complicated than setting interest rates.
As one policy adviser has pointed out, by 2008 the NHS will be consuming
something like 0.3 per cent of the gross domestic product of the entire
planet.
For people working in the NHS an independent board would come as a huge
relief if it meant they could get on with their jobs. But the suspicion
is that politicians find it almost impossible not to dabble — some
would say meddle — in NHS affairs.
They see that something is not working as well as it should or they wish, so
they introduce some new way of working. When that does not seem to do the trick,
they do not wait to see if time will help it bed down. They want a quick fix.
Julian Le Grand, a former health adviser to Tony Blair and now professor of social
policy at the London School of Economics, was quoted on BBC Online: “In
1948 the idea was that the politicians would set the budget and the people who
worked in the NHS — at that time thought to be only doctors — would
run it. The doctors started challenging the politicians to provide more money
and the politicians said if we are going to provide more money, they have got
to have some say in how that money is spent.”
Would this tension be dissipated by an independent board? Probably not. As soon
as a sensible, economic decision were made, say to close a hospital, and local
constituents started to complain, the local member of Parliament would find it
impossible not to bring pressure to bear in order to have the decision thrown
out and his or her seat secured — pace Richard Taylor, independent member
for Kidderminster.
In fact, we could argue that the NHS will never be safe if there is a politician
to hand.
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