Ten ways to be secretary of state for healthBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2954 (Published 02 June 2015) Cite this as: BMJ 2015;350:h2954
- Nicholas Timmins, senior fellow, King’s Fund and Institute for Government, London, UK
There is no handbook on how to be secretary of state for health. Well, up to now there hasn’t been. The Health Foundation, however, has got as close as anyone is likely easily to get by interviewing 10 of the last 11 former health secretaries—from Ken Clarke onwards—about what they think the role is, what it should be, and what it was when they were there.1
The move was prompted in part by Andrew Lansley’s decision, as part of his monster health act in 2012, to set NHS England up as a statutorily independent commissioning board—fulfilling, on paper at least, the long held desire of many in the NHS to somehow “depoliticise” the NHS by taking ministers out of the day to day management of the service. Seeking, in the words of Lansley’s white paper, Liberating the NHS, to end “political micro-management,” “political control,” and “political meddling” in the service so that the country could have an NHS “free from day-to-day political interference.” Given the complexities of the structure that Lansley created, this might, in the eyes of some at least, be a case of “be careful what you wish for.”
The idea of some sort of independent board to run the NHS goes back decades. The British Medical Association trailed it in 1970. The Royal Commission on the NHS in 1979 reported that “the establishment of an independent health commission or board to manage the NHS was one of the solutions most frequently advocated in evidence”—though the commission itself, while saying many of the arguments in favour “are attractive” came down against the idea.
The precise definition of what sort …