Every single one of his successors has felt the truth of that prediction: even when they managed to separate the NHS off to be technically independent, ministers have always been the ones to answer for the performance and failings of the health service.
Announcing the change to MPs, Streeting claimed it was something the Conservatives had secretly wanted to do but never managed. That’s not quite right: the Tories were indeed the ones who made the NHS operationally independent from the Department of Health in their disastrous 2012 Health and Social Care Act. They then spent the ensuing decade regretting those reforms, which were dreamed up entirely in the head of then Conservative health secretary Andrew Lansley.
As it happens, that reform wasn’t Lansley’s idea anyway. It was something he was randomly tasked with making work in the space of a weekend when David Cameron, on a whim, asked him to develop a policy to make the NHS independent, like the Bank of England. The minister and his aides were dumbfounded: in what way was the health service comparable to the country’s central bank?
For a long time, even colleagues who regularly cursed Lansley seemed to think the independent bit was a good idea: it removed petty political interference. And it suited ministers to have someone else to blame when something went wrong: the receiver of complaints should be the chief executive of the service, rather than anyone who would have to answer questions in the House of Commons.
square ISABEL HARDMAN
Wes Streeting is quietly seizing control of the NHS from the hands of bureaucratsRead More
Except it has never really worked that way, and nor should it. As Bevan foresaw, it will always be ministers who have to answer for the NHS performing badly. Besides, the idea of “taking the politics out” of public service delivery is an insult to the public, as it really means removing accountability from an elected government. Politics is the business of getting things done, but even politicians end up using it as byword for petty partisanship.
The real prize here is not being able to receive complaints direct, but being in control. Even though Streeting again insisted this week that he wants to decentralise the NHS and ensure that there is greater local accountability, he also clashed with the outgoing leaders of the service, including Amanda Pritchard, over the idea that he, rather than those officials, should be the one more closely setting the direction and pushing for improvements.
Many health service lifers have seen this film before, of a performance-focused management culture led by ministers: it was exactly what New Labour did when in office, too. Perhaps this time around, Streeting won’t follow some of the more controlling, unpleasant aspects of that culture, which bled down through the health service ranks in the form of fear of missing targets and bullying of staff by managers.
It’s funny how often a government ends up doing precisely the thing it said it wouldn’t. But one thing this Government cannot avoid doing is improving the performance of the NHS. Otherwise, it will end up bleeding for that failure, just as Bevan predicted.
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