For that small bandana-wearing group of NHS independence fighters, the Autumn of 2006 was something of a high-water mark. David Cameron told an audience in London that the Conservatives would publish an “NHS Independence Bill” to create an independent board responsible for allocating resources and commissioning services. Such a Bill, he said, would, if agreed across the parties and enacted by 2008, give the NHS its “best-possible 60th birthday present”. Andy Burnham, a health minister then but not yet Secretary of State, talked about creating an “NHS Charter”, similar to that which keeps the BBC insulated from political interference. Even the Chancellor Gordon Brown, planning his move next door to Number 10, was said to have had his head turned by the idea of an independent board. Independence, concluded the Kings Fund’s Anna Dixon, was the “big health idea” of that year’s party conference season.
And then what happened? Well, when the NHS came to tear open its birthday presents two years later, an Independence Act certainly wasn’t among them. Burnham was promoted to run the Department for Culture, Media and Sport where he got a close-up look at the BBC and its Charter, and seemed to be cured of his enthusiasm for transplanting the idea to health by the time he came back to Richmond House. Gordon Brown went off the notion of an independent NHS board as quickly as he had gone onto it.
It is arguably a mark of a lack of detailed scrutiny of the Conservatives’ policies that today they are still widely supposed to be standing strong for an “independent” NHS, despite having seriously downgraded their commitment to the policy. True, the notion of an independent board still survives in their draft health manifesto, but its job would be the geographical allocation of resources. This is a significant advance for independence only if you take the view (which the Tories do) that the current resource allocation formula is subject to ruthless gerrymandering to favour Labour areas. Commissioning, a much bigger deal, is no longer linked in the manifesto to an independent board. There is also a very clear statement there that “instead of bureaucratic accountability there will be democratic accountability” in the NHS. This implies (to this author at least) that people you vote for will have a bigger say. Where does that leave the idea of “independence”?
Paul Corrigan, a former health adviser to Tony Blair, recently observed in an article in the Health Service Journal that the Conservatives’ high-principled commitment to NHS independence is frequently sandbagged by realpolitik. Objective, evidence-based proposals for shutting hospitals or services are opposed by the local Tory candidate with the active support of the party high-command. Indeed, the Conservatives say that they would put all current “service reconfigurations” on hold until the case for change has been reviewed. They may genuinely believe a fresh pair of eyes is needed. Much more likely, the moratorium policy is a device to enable Conservative candidates get past awkward questions until the general election is safely out the way. The then Conservative government instigated a very similar policy in London in the run-up to the 1992 election, and for precisely those reasons.
To say all this is not to condemn the Conservatives as uniquely conflicted. Indeed, the last few years have seen the bizarre spectacle of Labour ministers – ministers, not just backbenchers – openly campaigning against hospital or service closures in their own constituency, put forward by their own government.
The point is that all this should be kept in mind while listening to any politician’s promise to “take the politics out of the NHS.” The health service spends over £100 billion of taxpayers’ money every year. It is never far from the top of the list of voters’ concerns. Moreover, the next few years will see some incredibly difficult decisions in pursuit of the £20 billion of savings that NHS chief executive David Nicholson says are needed to keep going on a flat budget. And the politicians are going to walk away from all this? Believe that and you would believe just about anything.
