If I were Secretary of State for Health, I would give my predecessor a very warm send-off. The range of initiatives emanating from his office has been heroic. But what a thankless task! The more he strives to cut waiting lists and preserve the NHS as the icon for all that is precious about Britain under New Labour, the harder the media try to catch him out with death-on-trolley sagas and – even more painfully – unflattering comparisons with abroad. With a rapidly ageing population, and with costly new drugs and technologies coming on stream daily, all health systems are, in truth, having trouble meeting demand. One that seeks to provide universal, free healthcare is likely to have more trouble than most.
Cabinet ministers should not seek to rescue the NHS as though it were a damsel in distress. Health is the key issue here, not the treatment and care of illness. We all want a world-class health service but more than that, surely, we want people not to need it. We want to keep them away from doctors and nurses by enabling them to stay well.
I would start by following the advice of Lord Haskins, who recently proposed a new legislative settlement that would locate the NHS at arms-length from government, as a publicly funded, public-interest corporation. This would operate a bit like the BBC, which is free to run its own affairs without day-to-day interference. The government would provide a strategic and ethical framework, raise finance (in this case through general taxation) and leave it to the NHS to deliver high-quality, equitable healthcare. Parliament would then hold government and the NHS to account.
Meanwhile, the new Secretary of State for Health could start to be just that – a champion and leader for health. We have had two excellent ministers for public health since Labour created the post in 1997. But they have not had the clout of a Cabinet minister and so far the health secretary has been almost entirely preoccupied with illness. This would not be a soft option. There would be three vital strands to the new health secretary’s portfolio, all of them highly demanding. First, It is time to recapture the initiative from the NHS-obsessed media – shifting the terms of debate and encouraging the public to understand why they get ill and what can be done about it.
Second, a framework must be developed for the new NHS Corporation that obliges it to behave in ways that are more, rather than less, likely to be health-enhancing. This is not about how it provides services, but about how it uses its formidable powers as an employer, purchaser, landholder and manager of buildings, energy, waste and transport. These are all factors likely to influence people’s health.
The third strand is to promote efforts across government, as well as by the NHS, to improve health and reduce health inequalities. There is plenty going on, in fact, but it could be more forcefully led and co-ordinated and reflected back to the electorate. It would mean an entirely new script for the Secretary of State, a new identity and a new set of priorities. It won’t be any easier, but it would be more rational and more in tune with the goals and style of a modern Labour government.