Yet no sooner are the little monsters scrubbed and dispatched to Key Stage 3 than Mr Milburn’s arms are twitching. By 10 o’clock his eyes are staring and by 2pm he is on the phone to Tony Blair screaming for a fix. So remember, Alan, power doesn’t get any easier. One more shot is never enough. And in your absence the place has gone mad.
Mr Blair has reportedly returned from holiday “tested by fire”. He regards the chief obstacle to his rule as not vague “forces of conservatism” but actual ministers. He has ordered his Cabinet Office Strangeloves — Michael Barber and Andrew Adonis — to invent fiendish new ways of measuring ministers’ performance. After beacon schools and beacon councils he now wants beacon ministers displaying “beacon behaviour”. I kid you not.
Last month the idea was given a run by Mr Milburn’s successor at health, John Reid. It is an Eighties management concept, doubtless emanating from Lord Birt, called “saturation bombing”. Mr Reid, an air-power enthusiast from his defence ministry days, duly staged a raid on West Yorkshire on August 1. He took five junior ministers, two officials and 12 “health czars”, pulverising the NHS landscape round Leeds. Hands were shaken, nurses spoken to, cancer centres opened, dispensaries visited. Mr Blair wants every corner of the realm to “feel the strength of Tamburlaine/ And by the state of his supremacy/ Approve the difference ’twixt himself and you”.
David Blunkett’s team will come next with local police forces, despite them being nothing to do with him. The departments of transport, industry and agriculture are said to be planning similar raids. The defence ministry may even get to bomb the Royal Air Force. Mr Reid is unaware that such “spasm management” is now discredited. It may boast central power, but it implies that the top has lost fluid communication with the front line. It implies that the bosses have no faith in their subordinates’ leadership but must go snooping for themselves. I wonder if Mr Reid’s doctorate really is in “economic history”?
Meanwhile, the Government’s efforts to centralise the NHS have become frenetic. The battle that led to Mr Milburn’s resignation was over foundation hospitals. The old foe, Gordon Brown, was determined to kill these cuckoos in the centrist nest at birth. Mr Milburn was determined to let them breathe. Mr Blair sided with Mr Milburn, so Mr Brown won. Mr Milburn was left awarding 20 so-called three-star hospitals the meagre title of “foundations”, with a Soviet-style “election” of governors. He resigned.
Mr Reid has done the Treasury’s bidding and emasculated the foundations. Hardly anyone voted for their governors, perhaps because only those invited to do so could vote. Fewer than 1,000 people, 90 per cent of them staff, voted for the governors of Guy’s and Thomas’ Trust in London. No foundation evoked the interest of 1 per cent of its catchment area. Mr Reid anyway said that any hospital that lost a star would immediately return to “performance-management by the NHS”. In other words, the hospitals were accountable to him, not any governors. It was a democratic travesty.
This was confirmed last week when The Times revealed that the whole venture was as good as dead. The foundation hospitals’ surpluses were being given to other hospitals. Bureaucratic oversight from 28 new Strategic Health Authorities was increasing, not being withdrawn. A “foundation hospitals regulator”, Bill Moyes, admitted that “it does look as if the old system of command and control is reasserting itself”.
These hospitals have suffered exactly the fate of Margaret Thatcher’s “trust hospitals” in the 1990s. The trusts were also to be independently managed, free of NHS control, able to raise money and retain surpluses. The NHS hierarchy, with Treasury help, simply refused to let it happen. The NHS is institutionally incapable of devolving power. Labour has tried the same process and met with the same failure.
Meanwhile, Mr Reid has followed another defunct consultant’s maxim, that of constant upheaval. Mr Milburn had already written a ten-year health plan and given himself the 2002 NHS Act with “58 new powers”. Mr Reid decided this was not enough. He instituted a “change programme”, refashioning 14 directorates into three “business groups” and pushing staff out to regional centres as a pretence of “culling” them. He has admitted that his 40 quangos have wasted a phenomenal £500 million a year. the NHS overhead has become such a cliché that its monstrousness escapes attention. Administrative recruitment under Labour has outstripped clinical recruitment by two to one.
By what imperial grandeur Mr Reid takes five ministers to West Yorkshire, where the NHS is supposedly based, is a mystery. As for his 12 in-house czars, even the Romanovs made do with one. The only saturation bombing needed by the NHS is on its own office. Meanwhile, Mr Reid could wield 60 targets in one hand and with the other write a pamphlet last year on “Localising the NHS”. In it he extolled diversity and said foundation hospitals were “moving beyond local managerialism into genuine local ownership”. He knows no shame.
The NHS, once the pride of Britain’s public sector, is now rated one of the least popular health services in Europe by the World Health Organisation. When Labour came to power, 41 per cent of British consumers expressed dissatisfaction with the NHS, against 10 per cent and 15 per cent for the German and French health services respectively. Today more than half of Britons still want the service changed, while 80 per cent of Scandinavians are content with theirs.
There is one clear difference between the NHS and other free health services in Europe. It is run as one vast organisation by a politician, Mr Reid, with 1.3 million employees. As a result its priorities are not set by local consumers but are driven by media scares and dispatch box rants between the Prime Minister and the Leader of the Opposition. Beyond that the only leadership is a miasma of Cabinet Office targetry. The result has proved such an incentive to distortion and mendacity that Mr Blair dare not risk the usual hospital photo-opportunity at this year’s party conference for fear of what may emerge.
The NHS is politically unstable. It lurches from scandal to disaster, the next one involving its chaotic “national computer”. It has served its time and must be dispersed. Its hospitals must return to being charitable trusts and administration must be entrusted to democratic local government, as is the case across the rest of Europe. Ministerial quangos are no substitute.
The obstacle is that this means delegating power over public money to properly elected citizens across Britain, and Mr Blair and Mr Brown will never do that. It would mean admitting that the NHS has lost public confidence and that the reason has been their own obsession with control.
The good news is that Mr Reid is getting a taste of his own medicine. He is being target-driven and performance-monitored by Downing Street. He and his colleagues will no longer answer to the House of Commons but to Mr Blair’s Delivery Unit. Their temple is to be Gradgrind’s Stone House, the Treasury, where common sense is “dragged into gloomy statistical dens by the hair” and where humanity is reduced to “a large black board with a dry Ogre chalking ghastly white figures”. Welcome back to the madhouse, Mr Milburn. Perhaps this time you will do as you are told.
simon.jenkins@thetimes.co.uk
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