This post is from The King's Fund Blog
Is Andrew Lansley’s grand reform of the NHS – otherwise known as the 2012 Health and Social Care Act – actually working? Or at least one part of it?
That might seem a truly daft question when the health service is clearly under enormous pressure, with plenty of normally sober people bandying about the word ‘crisis’.
But consider this. The NHS has had its fair share of financial crises before. This time round, however, everyone knows how far and how fast things are deteriorating because these days a plethora of data – about waiting times, delayed discharges, cancelled operations and the like – is published that simply did not exist before.
Yet so far, Health Secretary Jeremy Hunt has proved to be made of Teflon. He can go on the radio and declare elements of the performance ‘unacceptable’ while explaining, almost like a chief operating officer, that he’s trying to work out why some A&Es are coping and others are not – and then emerge apparently unscathed. Meanwhile, his press office turns down requests for comment on the problems in A&E because such things are apparently ‘operational matters’.
And he can do all that despite the weekly Monday morning meetings when he demands performance updates and grills the various representatives from NHS Improvement, NHS England, the Care Quality Commission and other national bodies; despite calling up hospital chief executives from time to time, like any good chief operating officer; and despite being, ultimately, responsible for the performance of a tax-funded service.
Instead it is Simon Stevens, Chief Executive of NHS England, taking much of the heat and having to explain, ever so gently, that money the government has provided for health and social care is not in fact what was asked for in his famous NHS five year forward view.
In other words, this time round the politicians appear to be escaping the ultimate responsibility. One of Lansley’s key aims, by creating a statutorily independent commissioning board in the shape of NHS England, was to ‘de-politicise’ the NHS, with the White Paper that launched the reforms finding seven different ways of saying that he wanted to take the politics out of the NHS. So has it – to this extent at least – worked?
For those of you with sufficiently long memories, think back over past financial crises. In 1987, no one held Len Peach, then Chairman of the NHS Management Board, responsible for the financial crisis that led to the Margaret Thatcher’s review of the NHS – the one that, in turn, led to the introduction of the ‘purchaser/provider split’. That crisis, and his performance during the review, ultimately cost John Moore his job as Secretary of State for Health and Social Security.
During the winter of 1999–2000 (the crisis that led to Tony Blair’s famous pledge to get NHS spending up to EU levels and then to The NHS Plan of 2000) no one held Alan Langlands, then NHS Chief Executive, responsible – at least in public. And Alan Milburn, on whose watch this happened, has since admitted that had he been Secretary of State for more than a few months (he had been Health Minister before but had spent the previous 18 months as Chief Secretary to the Treasury) he might well not have survived.
The more recent financial crisis in 2005 was a very different sort, caused not by there being too little money, but by the NHS quite remarkably managing to overspend in a period of record growth. That, along with other factors, ultimately cost Nigel Crisp, then NHS Chief Executive, his job. And for all the criticism she faced, Health Secretary Patricia Hewitt probably only survived because, like Milburn, she had only just taken over the post.
But Jeremy Hunt has been Health Secretary since September 2012, and at well over four years he is the second longest-serving health secretary since the NHS was founded, after Norman Fowler. He appears to be floating free while Downing Street anonymously briefs against Simon Stevens, although heaven alone knows who they think they would get to replace him.
So here’s the question. Has Lansley’s creation of a statutorily independent commissioning board – NHS England – to ‘de-politicise’ the NHS in fact succeeded? To this extent at least – that Jeremy Hunt is apparently not responsible for what is happening on his watch?