The new Health Secretary, Alan Johnson, has, unlike his predecessor, an excellent bedside manner. Our times2 interviews today with NHS staff suggest that he will need every gram of his charm if he is to soothe the clinicians, nurses and managers whose morale seems to have hit yet another all-time low. The Royal College of Nursing will ballot its members on industrial action this month, and Unison, the public sector union, plans to ballot its health members in September. It is, of course, the way of these unions to exaggerate the gloom and to trade on a pessimism that is more anomie than anatomy.
The Prime Minister has made the NHS his priority. He is acutely aware that what used to be a cast-iron poll lead for Labour on health has evaporated. It is no longer possble to depict the Conservatives as would-be wreckers of the system. Moreover, doctors’ gripes are politically influential, even if they are mostly unfounded.
Mr Johnson and Gordon Brown cannot spend their way out of this particular problem. For a start, the fresh funds available are diminishing. And stuffing physcians’ mouths with gold has only made some of them grumpier. It is a paradox that NHS morale is supposedly at rock bottom, while spending has never been higher.
Many dedicated professionals feel exhausted by reorganisations whose primary effect, they believe, has been to increase bureaucracy. Management ranges from the excellent to the truly mediocre. And living with political whim can be infuriating: Labour abolished the internal market only to resurrect it. But the changes are disliked not only because they are disruptive; they are also anathema to a service that remains highly tribal and unionised. The fact is that some of the reforms which have been most fiercely resisted such as allowing paramedics to answer 999 calls and opening up elective surgery to private competition are those that have most radically improved standards and efficiency.
No amount of sedative from the new NHS review which will be conducted by Sir Ara Darzi, the surgeon turned junior minister will disguise that the interests of the professionals do not always chime with those of patients. Few GPs will let patients make appointments in the evenings and weekends, for example. NHS workers loathe top-down targets. The target regime has indeed been overdone, and Mr Johnson has promised reform, but some targets are essential to drive improvement and to allow patients to judge performance. Many of those professionals surveyed in times2 today call for an independent board to run the NHS. But comparisons with the Bank of England’s Monetary Policy Committee are misleading. Politicians should not farm out what will always be political decisions. An independent board dominated by professionals would be bound to favour the producer over the consumer. This would imperil the courageous reforms that have started to improve life for patients, by changing the professionals’ habits.
Advertisement
This Government’s reforms were never intended to make staff “happy bunnies”, the strange phrase that Mr Johnson used last week. They were intended to change the NHS culture. Mr Johnson is right to worry that staff are disgruntled: they should be proud of what they do. But he must not let that culture stifle further progress towards improving outcomes for patients. The NHS review may sweeten the tone, but the diagnosis must remain clear, honest and uncompromising.