The Prime Minister's NHS interventions

January 08, 2008 11:10 AM

The Telegraph has an excellent leader today describing the absurdities of political management in the NHS:

"There is something faintly absurd in the spectacle of Gordon Brown - who is, after all, a politician, not a medical professional - making detailed recommendations for clinical practice in healthcare.


But in Britain, we have become so accustomed to the concept of a politically driven health system that it no longer seems bizarre to hear such proposals as the deep-cleaning of hospital wards and the prescribing of specific screening procedures being made by the Prime Minister, whose judgments must be no more expert than those of an informed layman."

Our centralised and monopolistic health service does not face the imperative to improve standards and deliver good value that hospitals and insurance funds face in countries like the Netherlands - with its more competitive system.  Customers are not able to abandon the poor service delivered by political management unless they can afford to pay twice - through the tax system and a private channel - for their treatment.


Another thing to note about these interventions is that they are being led not by Alan Johnson but by Gordon Brown.  This is a further centralisation that makes the Prime Minister - and the limited number of priorities that any one man can keep track of - a powerful limitation on the set of issues that politicians can reasonably expect to keep a track of.  Central authorities are unable to keep track of everything that needs doing but are still able to dictate priorities thanks to targets and financial control.  It is easy for them, and by extension the entire system, to neglect important work that isn't a political priority, like making sure soldiers' homes are fit for heroes.  Or, put off vital decisions till another day - the late decision to increase nuclear power capacity, for example.


Political management, by ministers with little management experience or subject knowledge, cannot deliver proper standards in public services.  Prime Ministerial management is just about the only way to make things worse.

The Telegraph has an excellent leader today describing the absurdities of political management in the NHS:

"There is something faintly absurd in the spectacle of Gordon Brown - who is, after all, a politician, not a medical professional - making detailed recommendations for clinical practice in healthcare.


But in Britain, we have become so accustomed to the concept of a politically driven health system that it no longer seems bizarre to hear such proposals as the deep-cleaning of hospital wards and the prescribing of specific screening procedures being made by the Prime Minister, whose judgments must be no more expert than those of an informed layman."

Our centralised and monopolistic health service does not face the imperative to improve standards and deliver good value that hospitals and insurance funds face in countries like the Netherlands - with its more competitive system.  Customers are not able to abandon the poor service delivered by political management unless they can afford to pay twice - through the tax system and a private channel - for their treatment.


Another thing to note about these interventions is that they are being led not by Alan Johnson but by Gordon Brown.  This is a further centralisation that makes the Prime Minister - and the limited number of priorities that any one man can keep track of - a powerful limitation on the set of issues that politicians can reasonably expect to keep a track of.  Central authorities are unable to keep track of everything that needs doing but are still able to dictate priorities thanks to targets and financial control.  It is easy for them, and by extension the entire system, to neglect important work that isn't a political priority, like making sure soldiers' homes are fit for heroes.  Or, put off vital decisions till another day - the late decision to increase nuclear power capacity, for example.


Political management, by ministers with little management experience or subject knowledge, cannot deliver proper standards in public services.  Prime Ministerial management is just about the only way to make things worse.

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