THE NHS: OUR BIGGEST REGRETS
As the UK’S healthcare service reaches 70, seven former health secretaries look back on their time at the helm – and to its future
As the NHS approaches its 70th anniversary, it faces a continuous battle to meet growing demand.
Here, former health secretaries recall the highs and lows of their tenure, and share their ideas on what can be done to preserve the future of the organisation.
You can read more from our “NHS at 70” series at telegraph.co.uk/nhs70
Lord Fowler 1981-1987
The issue that converted me wholeheartedly to the cause of public health was the Aids crisis of the late Eighties. We were confronted by a disease where knowledge was sparse, where there was no known treatment, let alone cure, and where death was the almost certain outcome. What we could do, however, was to warn the public of the dangers.
The result was the biggest public health campaign since the war. Our slogan was “Don’t Die of Ignorance”, which can be applied to a range of other conditions today.
The campaign may have been controversial, but our follow-up surveys showed that more than
90per cent of the public supported it, and the number of people contracting HIV leading to Aids reduced.
My regret is that we did not extend our approach into other areas with the same determination. Consistently followed policies would result in less pressure on the health service, less cost to the taxpayer and, above all, better lives for tens of thousands of men and women.
Kenneth Clarke 1988-1990
When I was appointed, Margaret Thatcher had already announced that she was going to reform the NHS and had appointed a secretary of state to do it. Unfortunately, he was taken ill, so I was unexpectedly called in.
Margaret’s idea of reform was to move to the American system, where everybody should be insured, preferably with a private insurance company, and the state would provide insurance or medical cover for those who could not afford it. I flatly disagreed, having got my idea of purchaser provider reform from reading the suggestions of an American economist. This led to my first month being beset by blazing meetings between us, before the prime minister realised I was not going to change my mind.
Introducing the so-called purchaser provider system set off the most extraordinary political controversy – the BMA had posters all over the country denouncing me. It was a ferocious political row, even by Thatcher standards.
The point of the reforms was to actually concentrate on what we were delivering to patients, and getting value for money. This was regarded as revolutionary, and I don’t think the NHS would still be here if we hadn’t done it.
Lord Waldegrave 1990-1992
Just before Mrs Thatcher’s fall, she summoned me with senior officials and the chief executive of the NHS to No10 for a review of Kenneth Clarke’s plans. It was clear to me that she was very cautious about the reforms, as she was about any change in the NHS whatsoever – after all, when she had appointed me, it was with the instruction that “Kenneth has stirred them all up: I want you to calm them down.”
I still believe that devolution of management to trust hospitals and other providers was right; what I regret is not tackling the contentious subject of funding. I was given a good settlement by the Treasury, partly because there was an election on the way. But start-stop funding is hopeless, which is why I welcome the Government’s talk of a long-term settlement now: it would enable far more efficient planning. I think we should look again at the mixed funding systems of other countries, and at hypothecation, in the form of a revised National Insurance system.
Virginia Bottomley 1992-1995
My task was to embed the NHS reforms that became known as the internal market. As a result, the service was better costed, and better costing means more care.
The Patients’ Charter outlined the expectations patients should rightly have, and the launch of the Health of the Nation White Paper, England’s first comprehensive and systematic public health strategy, set improvement targets for coronary heart disease and stroke, cancer, mental illness and more. The NHS,
like all large organisations, needs leaders that understand and focus on the long-term. Despite their best intentions, politicians face structural constraints on their ability to fill the role of a long-term leader. Ministers may be there one week and gone the next.
I had personal priorities, too: to insist that the NHS should be an employer of choice, and particularly to support diversity and inclusion. As the largest employer of women and large numbers of professionals from black and ethnic minorities, there was no excuse to have almost exclusively male and pale leadership.
All any of us hopes to make is a lasting impact on this remarkable service.
Stephen Dorrell 1995-1997
The role of health secretary involves the unique combination of managing one of the largest employers in the country and delivering social policy objectives. Equitable access to high-quality healthcare is key to most people’s idea of social justice. This makes people instinctively cautious and conservative about changing the organisation, but, of course, it has to change if the values are to be continued to be delivered.
We should see the NHS as part of the range of services delivered to the community, and think about the links not just between health and social care, but between health and housing, education and alcohol services. Galvanising all these services to prevent ill health is going to be vital as the proportion of elderly and dependent citizens in our society rises.
These services are provided by a complex network of state, not-forprofit and private-sector agencies. A public service is just that: a service provided to the public; the question of who provides it is secondary.
Patricia Hewitt 2005-2007
About four months into my tenure as health secretary, the entire top team of the Department of Health sat me down at my very large meeting table, looking very worried. It was straight out of Yes,
Minister. “We have a problem,” said the permanent secretary. “The NHS has overspent.”
The overspend was £250million, a sum that Jeremy Hunt would be delighted with if it was reported to him today – but, back then, it was devastating. We began holding daily meetings and set up quarterly reports; I was shocked at the complete lack of financial discipline in an organisation spending £100billion a year. There were hospitals who couldn’t even tell you how many people they were employing.
We turned the situation around and delivered the first productivity improvement for years. My proudest achievement is the introduction of the smoking ban, something people still come up to me in the street and thank me for.
I would have liked to have gone further on public health and prevention: I was in favour of an increased tax on alcohol, but Tony Blair was very worried about being seen as a nanny-state government. Now, I think there is much more sympathy for those kinds of ideas.
Alan Johnson 2007-2009
When the NHS was created, Nye Bevan said: “Expectation will always exceed capacity. The service will always be changing, growing and improving; it must always appear inadequate.” I saw, first-hand, his words in action – even when presiding over an NHS that was receiving annual real-term increases of six per cent.
Ironically, it was my government’s determination to bring patient waiting times down from an average of 18 months to no more than 18 weeks (and an average of nine) that caused us the most grief.
The Right attacked us for setting targets and the Left accused us of “privatisation”. In my two years as health secretary, we met our target of 95per cent of outpatients and 90per cent of inpatients being treated within 18 weeks. In an organisation as large as the NHS, that would have been impossible without targets.
The increased budget allowed us to do many good things, such as transform mental health provision by beginning to recruit 3,600 psychological therapists to work in GP surgeries, but there was also the scandal at Stafford Hospital, where they had reduced clinical personnel to the extent that a receptionist with no medical training was triage nursing in A&E.
I had the good fortune to be health secretary during the NHS’S 60th anniversary, where I spoke with people who recalled the creation of the service. It is a principle, as unifying and inspirational now, as it was 70 years ago.