Magazine article The Spectator

'We Need to Be Ready for Two Yaers of Recession'

Magazine article The Spectator

'We Need to Be Ready for Two Yaers of Recession'

Article excerpt

Opposite Alan Johnson's desk is a plaque from the Chinese health ministry -- a gift that must, at times, seem like a taunt. The Health Secretary controls 1.3 million staff, more than anyone bar the commander of the Red Army. His £120 billion budget is greater than any government department in Beijing. The Chinese economy and the NHS were both subjected to limited market-based reform -- yet there the similarities end. Deng Xiaoping succeeded. Tony Blair was ousted. And now Mr Johnson stands in charge of the largest bureaucracy on the planet.

We have heard strikingly little about health since he took over, which he regards as a success. The Blairite health reform agenda had led to the most bitter feuding in government -- at one stage, a Gordon Brown doll was dangling from a noose at one desk in the health department. His predecessor, Patricia Hewitt, latterly needed bodyguards when she went to speak to nurses. Now the ever-smiling Mr Johnson has calmed the department. The reform agenda has not died, he argues -- it has just been rephrased.

'The task we set ourselves was to change the language, ' he says, reclining in his office sofa. 'You have to find a way of talking that takes people with you. Before it was all managerial-speak -- practice-based commissioning, payment by results and all of that. It's not language that people relate to in the health service.' Surely it is more than that, I ask: what about those cancelled contracts for the private clinics that had been expected under the Blair years to carry out up to 10 per cent of operations?

His answer is fascinating. Contracts were cancelled, he said, because they were not needed: the very threat of competition unblocked NHS bottlenecks. 'When you introduce these [private] centres, you find that performance suddenly zooms in the local NHS hospitals that had previously said they couldn't do any more hip replacements, ' he says. 'So you had to decide if taxpayers' money would be well spent on a lovely spanking new [private] centre that very few people would use.' All this is testimony, one might argue, to the power of competition. So why not have more of it? Stir them up even further?

'We're not doing these things for the sake of it, as an ideological challenge, ' he says.

'We're only doing what is necessary for the health service. So the capacity issue is still central to this.' If he thinks the Blairites were being ideological in the pursuit of the internal market, he does not say so in these terms. But it is hard to think he was referring to the Tories.

Instead of accusing Mr Johnson of caving in to the unions (a charge made by a few of the Blairites), Andrew Lansley, his Tory counterpart, is attacking from the other direction. The central Tory proposal is to grant operational independence to the NHS. Mr Lansley says that the NHS has had too many re-organisations, and it would have an independent board under the Tories to ensure it is not so disrupted in the future. This, Mr Johnson says, runs the risk of leaving the health service dangerously unaccountable.

'The NHS, love it and bless it, concentrates on issues that it sees as priorities, ' he says 'For example, a clinical discussion can go on in hospitals saying mixed sex accommodation is not so important. But the public feel it is important.' Last month, he gave the NHS 14 months to have men and women in different wards -- an order which he says a Tory health secretary would be unable to make. …

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