The Guardian notes the governments plans for NHS returns today.
I admit I have not read these plans in as much detail as I would like. There is good reason for that. I have some fairly pressing commitments that are reducing time availability for very much else this week. But I still think some thoughts are appropriate.
First, I campaigned hard against the 2012 NHS reforms from Andrew Lansley and David Cameron. I recall it being suggested in an academic paper that I was the fourth most active person in social media to do so. Unsurprisingly I do, as a result welcome a move that reverses some of the damage those reforms delivered, including the denial of ministerial responsibility for the NHS implicit in them.
But, secondly, we are now in a very different place from 2012. That’s partly because of Covid, of course. That alone suggests that the timing for this reform is wrong. A review into Covid and the issues it has raised for the NHS seems to be much more important than hasty reforms at this moment.
Third, a focus on wellbeing and not process might also be appropriate as the focus of reforms. 900 NHS staff have, I think, now died as a result of Covid. Almost none of them are ICU staff because they have enjoyed the protection that they have needed from this virus. Others have not. The lessons for an organisation that under current management so clearly fails to care for its staff also need to be learned before reform is considered. That, though, would require consideration of funding, and I rather suspect that is not on the agenda right now.
But talking of funding, there is a fourth concern, which also emphasises how much has changed since 2012. Then I assumed an NHS under ministerial control would be less exposed to risk of corruption and deliberate misallocation of resources than one under devolved, or private sector management. Since then though cronyism has become the modus operandi of government, with considerable effort being expended to keep it that way by, for example seeking to bankrupt challenges to this corruption from The Good Law Project. As a result I am no longer sure that ministerial control by a person who appears quite happy for his friends to secure lucrative NHS contracts without any apparent qualifications to do so is quite such a good idea. It is staggering how far we have fallen in such a short time that I have to now consider this.
So, fifth, the control mechanisms seeking to prevent abuse of one of the biggest budgets in government is critical to this reform programme.
Added together, I am concerned. But most of all, my concern is that I have lost faith in the good faith of ministers, from whom acceptable behaviour can no longer be assumed the norm. This government might has a consequence achieved its aim. It is destroying confidence in government itself. And that is shocking.