Saturday, 17 January 2015

The sleepers awake. How the left controls NHS leadership.


Back in the 1980s the Conservative government did that very conservative thing - it decided that the way to improve the operational effectiveness of public services like the NHS was to get better leadership and management. It's very hard to argue with this principle, indeed it seems like common sense. So the government replaced local councillor led area authorities with a mish-mash of boards and panels each with people recruited to bring 'business' experience of one sort or another.

Spin forward a few years and we arrive at 1997 and the election of a Labour government. Now some on the left wanted to return to the old, pre-reform NHS where the organisation was centrally directed with no pseudo-market and no boards of 'business' people. But Blair and Brown decided otherwise - they realised that the boards in the NHS presented the opportunity to fill the organisation with people sympathetic to New Labour's aims (I'm talking about the NHS here but the same applied right across the public sector).

Once the key appointments - chairs, chief executives and so forth - were in place, Labour could rely on those people to fill the boards with like-minded folk. And, by introducing (in typical New Labour style) a control mechanism - the Nolan Principles - this could be portrayed as removing political interference from the appointment process. The board may be filled with apologists for Labour (and indeed, as we find in Bradford, with actual Labour politicians) but these supposed 'principles' allow that party to claim it has nothing to do with the appointment - the best person got the job.

When Labour left government some assumed (and to see the spat over just one appointment, Labour absolutely believed) that the Conservatives would apply exactly the same approach - chairs and directors would be chosen for their Conservative sympathies. But this simply hasn't happened because of that view, a deeply conservative view, that it's effective administration that matters - as I wrote a while back:

...Cameron’s “conservatism as effective administration” requires attachment to and confidence in institutions – the National Health Service, the Civil Service, Royal Colleges, Universities. Government should concern itself with ensuring these institutions are well administered rather than with the outcomes of the institutions work. Put the right leaderships in place and trust in their judgement is what government must do – and then act to implement and enforce the plans those leaders create.

So the urbane, professorial sorts who lead publiuc institutions remained in place despite their preference - even support - for the Labour Party. The result of this is that - especially in the NHS - the administration actively seeks to undermine the priorities and direction of government policy. And with the 'privatisation' debate the Labour-supporting men and women filling NHS boards have been activated in the manner of sleepers:

Party activists sat on board that slashed funds, doctor who is would-be Labour MP helped shape critical report and lead inspector was opponent of privatisation 

We are reminded again how the Labour Party and its supporters in trade unions like the BMA will always put the interests of power and self-interest ahead of the interests or the public and the patient. And this revelation reminds us that the biggest failure in the current government's administration of the NHS hasn't been the reforms or funding issues but has been keeping a huge fifth column of Labour supporters in place right across the system. Indeed, to allow those supporters to continue appointing their own to positions of power and influence in the NHS.


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