‘In Stoke-on-Trent last month, Liz Truss and Rishi Sunak traded blows over everything from credit card economics to Channel migrants…The list of issues …was dizzyingly long. There was one glaring omission, however…In the hour-long debate there was not a single mention of the NHS.’ Andrew Gregory Health Editor, Guardian, 30 August 2022
Gregory charted the NHS crisis which the two contenders had ignored. 105,000 vacancies. During July 29,000 people waiting over 12 hours in English A&E departments. Ambulance response times (target 18 minutes) average 59 minutes. One in seven hospital beds occupied by patients who cannot be discharged. Nurses and doctors threatening strike action.
A week earlier, Sajid Javid, who was for just a year Secretary of State for Health and Social Care was asked what he thought of proposals for the NHS put forward by the different candidates? He began like this.
‘Of course I speak as someone who until July was running the health service’.
It may sound impressive to say that as a minister, you have been ‘running the health service’. Yet it is misleading. It reveals attitudes which may help to explain the inability of successive well-intentioned Ministers of Health and Social Care to make lasting improvements.
A government minister speaks of ‘running’ the NHS. Pressed by a constituency MP about the shortcomings of a local maternity or mental health unit, they feel impelled to speak as if they will personally intervene to sort things out. Each dynamic-sounding ministerial intervention undermines the hands-on leadership of those running that service.
Sir Tom Winsor’s new report on the ‘constructive dismissal’ of Cressida Dick criticises Sadiq Khan, a Labour politician who has crossed the line that should separate an accountable political leader from inappropriate interference in a public service. Winsor describes a situation where
‘a determined politician has created conditions which apply undue, oppressive and perhaps intolerable pressure on the Commissioner’, in particular by threatening to make a public statement of no confidence irrespective of the grounds for doing so’.
Politicians of both sides need reminding of the obligations owed to those who have the difficult job of running things.
In the last of the leadership hustings Liz Truss was asked if we might need electricity rationing this winter. To applause, she insisted that would not happen. Energy specialists were quick to point out that Liz Truss was not in a position to say this: the choice may well be between orderly rationing and chaotic blackouts. She too was confusing the role of those who run things from those who govern.
Politicians need to be good listeners; they need to map and understand the complex and interdependent systems over which they preside; to recognise that with every intervention, an elected politician may make things worse; to be rigorous in delegation to officials and managers; to respect the difference between running something and setting its policies and priorities; to balance the short term and the long term; and above all to be a patient steward, determined to hand on the process to a successor in better condition. Humility is required: major changes can take four to five years to bed in while the average term of office of a UK Cabinet minister is less than two years. [i]
The best ministers understand that Government is not joined up. They look beyond departmental boundaries. Instead of claiming to ‘run the health service’ wise ministers would admit that the NHS is an illness service; the foundations for health are laid in how we educate our children about nutrition and exercise; how we tax and regulate food production in ways that discourage obesity and promote health; how we discourage the poisoning that comes from too much urban vehicle use; how we invest in local authority care and other service to take pressure of the NHS.
Yet these systemic perspectives don’t help to get anyone into the job of government minister. The gap between promise and performance is growing.
One only has to look to recent history here and in the USA to realise where this can end. Contempt for experts. Populist promises disconnected with reality. – ‘Take Back Control’ ; Make America Great Again’- and the stoking up of hostility towards those who base discussion on the facts.
National discussion needs realism. It needs to respect those who have run things. People who will ask:
– How will this policy work?.
– What is the experience of this approach when tried elsewhere?
– What are the major risks?
– If you were arguing against the strategy what would your strongest argument be?
– Have you talked to the people who will have to implement it?
– How long will you stick to the policy even if, at first it doesn’t seem to be working?
Peter Ward, Chair of Telos Partners said recently.
‘What should be the qualifications to be met by people seeking election? Is it enough that they have worked in a research function in their party’s central office. Or as a special advisor working for a minister? Shouldn’t there be some kind of apprenticeship or evidence of public service before anyone can become a parliamentary candidate?’
For those who have not given birth and raised children – a tough apprenticeship – perhaps two years’ experience in a job that requires either service to others, or physical work or some combination of the two?
Something is badly amiss in our democracies. It would be helpful if, instead of claiming that they ‘run’ anything, ministers would respect and listen more to those who are running things.
Mark Goyder is Founder of Tomorrow’s Company and Senior Advisor to the Board Intelligence Think Tank. He is the author, with Ong Boon Hwee, of Entrusted – Stewardship for Responsible Wealth Creation, published by World Scientific in 2020.
[i] Richard Reeves and Hugh Cleary looked at this for a Demos report in 2009 and the average then was 1.3 years! I have assumed it may have increased a little. https://www.demos.co.uk/files/Ministerial_Churn.pdf