Confined to public health, focused on health outcomes, and at arm’s length from the NHS through the annual mandate – this was never going to work under normal circumstances, never mind when an election is looming and with the budget settlement for the NHS as it is.
The Secretary of State will want to direct and grip more, sure perhaps not back to Milburnesque proportions but enough to create the right aura of ‘the NHS is safe in our hands’ in the stretch to 2015.
Many ideas Secretaries of State want to pursue, have not been tried before – evidence is thin or non-existent, or may come from another country in which the context is completely different
Leaving aside any irritation this might cause with NHS England, and indeed other arm’s length bodies (ALBs), or confusion with the service (who may have imagined significant autonomy), steer from a Secretary of State may not necessarily be a bad thing – if it is good steer.
You will have your own list, but the obvious enemies of good steer by any Secretary of State include the following: short timetable to show results; having to be competitive with colleagues around the Cabinet table to produce that administration-defining policy; having to outshine the previous Secretary of State or Party’s handling of the NHS; lack of experience/instinct/decisiveness/powers to listen; and being given poor advice (in part based on weak evidence).
As long as the NHS remains tax funded (long may that remain) the first four enemies seem inevitable. It is the last area that you and I can hopefully try to make a difference.
I use the word ‘advice’ over ‘evidence’ because many ideas Secretaries of State want to pursue, have not been tried before. Evidence is thin or non-existent, or may come from another country in which the context is completely different.
This is where experience comes in – policy experience perhaps, but more often experience from the ground as to what might best work and how. In SW1 there may be some policy experience but knowledge of the front line is limited or out of date.
Yet it is this which can be the effective buffer zone to prevent the NHS receiving random political policy shocks and taking blind alley detours away from more sensible evolutionary paths.
This is where the wisdom of crowds comes in. Have a look at our report and you’ll find wise counsel. More than that, you will find overwhelming consensus on the big issues of the day for health care, which politicians may not acknowledge in the pursuit of manufactured dissent with those of another ideological stripe.
Given the challenge ahead wouldn’t a temporary truce be a good idea? Is that so very difficult?
Pulling together a book, debates, web materials, seminars to cultivate and grow that buffer zone is one thing – having the crowd wisdom effectively shape policy is another harder task.
Here there is real work to be done. In our own way, foundations like the Nuffield Trust, The King’s Fund and the Health Foundation can be beacons of stability in pursuing this agenda, when there is turbulence and vested interest elsewhere.
After five very rich years with my colleagues at the Nuffield Trust I move on to lead the Health Foundation in October, and look forward very much to keeping on the case with colleagues there and elsewhere.
Until then, have a great summer. Over and out.
Dixon J (2013) ‘The wisdom of the crowd: summer reading for Whitehall villagers’. Nuffield Trust comment, 1 August 2013. https://www.nuffieldtrust.org.uk/news-item/the-wisdom-of-the-crowd-summer-reading-for-whitehall-villagers