We’ve failed to hold the NHS chief executive to account

It was Ken Clarke, apparently, who once likened walking into the Department of Health to entering a signal box with half the levers missing. The decisions which matter, the control of a budget which exceeds many countries’ GDP, were all being made elsewhere. The role of the health secretary, as Steven Barclay has no doubt worked out by now, is to provide a veneer of democratic respectability to an organisational monster that has attained a life of its own – as well as, of course, to engage in the annual round of begging to the Treasury.

Still, you sense at times that it suits ministers to have their areas of responsibility farmed out to quangos and agencies over which they have little direct control. It distances them from the seat of disaster when things go wrong, allows them to shift responsibility away from themselves and away from the government. Just look at how Grant Shapps, like every other transport secretary, shrugs his shoulders every rail strike and says it is a matter to be settled between rail companies and unions.

But it really won’t do to have a Potemkin government department with little direct power over such a bigspending public body like the NHS. State healthcare lies at the heart of our democracy. It is one of the issues that dominates every election. It is not good enough to have decisions as to how our billions are spent being made by anonymous public servants rather than ministers of the government whom we elect.

Who has even heard the name Amanda Pritchard? If you weren’t aware, she is the chief executive of NHS England – the real health secretary, you might call her. It is she who decides how much of our billions in taxpayer funds is allocated across the health service, the priorities on which care is rationed (and let’s be honest, it is rationed, just like any other goods or services which are free on the point of delivery).

If you have heard of Ms Pritchard at all it is quite likely to be because of her gaffe last November when she claimed that there were 14 times as many Covid patients in hospital than there had been at the same point in 2020. In fact, at the time she made her claim, there were 7,075 Covid patients in NHS hospitals in England, compared with 11,680 on the same day the previous year. It turned out that she had been comparing figures with August 2020 – an “outrageous use of statistics,” as one statistician at the University of Sheffield put it.

It is not hard to imagine what would have happened had the health secretary had made the same claim in the Commons. He might possibly have been dragged before the standards and privileges committee before he could sneeze, for misleading MPS.

If we are not going to have a health secretary who is genuinely in charge of the NHS – ie, if Steve Barclay is not going to be the de facto CEO – then at the very least Ms Pritchard should be made more accountable before MPS. She should be obliged to attend regular question and answer sessions where any MP can challenge her, not just the occasional appearance before the health and social care select committee. She would have to make herself more available for examination by journalists, too.

The NHS has a serious access problem at the moment, with many patients reporting that they are finding it difficult to get a GP appointment. GPS should not be hiding away behind online and telephone “triage” systems where they can filter out patients. And neither should the NHS chief executive. Voters care deeply about the NHS –it should not be able to hide behind the often-powerless bureaucracy that is the Department of Health. The people who run our largest national employer need to be brought into the open and the whole thing put under more democratic influence.

Amanda Pritchard is the most powerful person you have never heard of, making decisions that will affect the health of us all