Mandarins take reins as NHS battle hots up: The future of the national health service will be a trial of strength between a giant NHS commissioning board and thousands of family doctors across England
With the arrival of the NHS commissioning board, the biggest quango ever created, with direct control of £25bn, the health service has entered the age of Davids. While much has been made about how tightly Jeremy Hunt, the new health secretary, will embrace the private sector, real power is now in the hands of three mandarins: David Behan at the Care Quality Commission (CQC); David Bennett at Monitor and Sir David Nicholson at the board.
Of these, Nicholson, with an impeccable NHS pedigree, is the most important. He is not, in the parlance of former health secretary Andrew Lansley, one of nature's "liberators". By reputation, he remains an arch-centraliser, preferring to run things from the impregnable heights of power. As the commissioning board will oversee GPs – and the £60bn they will spend – the future will be a trial of strength between a giant board and thousands of family doctors across England.
Lansley's gamble was that the 8,000 GP practices would prove impossible to police with the zeal of a political commissar. However, so far, Nicholson has proved able to impose his view on the service – for example, ensuring private companies don't do any of the commissioning for GPs. He will also pop up if a clinical commissioning group goes bankrupt – to ensure failing partners will be made accountable. The Treasury, it is said, was particularly keen to have someone at the board with a firm hand on the tiller.
All this is important because GP commissioning is the one policy Labour's health spokesman, Andy Burnham, and the coalition can agree on – with the role of the CQC and hence of Behan clouded by the Francis report into the Mid Staffs debacle. Labour's health policy has come under close scrutiny this week. Much has been made of the apparent confusion between the call from Burnham to "repeal the Health and Social Care Act" and Labour leader Ed Miliband's claim not to "reverse it all back". In fact, Miliband and Burnham are on the same page, although reading from different parts of it. What Miliband appears to be against is turning the NHS into a regulated industry, operating under rules set by Monitor – the new economic regulator.
The coalition thinks the NHS should become more like the telecoms or gas industry. Lansley, a former civil servant who piloted privatisations in the 1980s, knows the arguments well. He's been making them since 2005.
Labour's policy is bad news for Bennett, the Monitor chairman, who had been a senior partner at McKinsey and head of the Downing Street strategy unit under Tony Blair. Bennett nailed his colours to the mast in early 2011 when he said: "We did it in gas, we did it in power, we did it in telecoms … We've done it in rail, we've done it in water. So there is actually 20 years' experience of taking monopolistic, monolithic markets and providers and exposing them to economic regulation."
This doesn't sit easily with Burnham's "one budget, one system" mantra for Labour's NHS. The creed of competition and choice, which fell so easily from the lips of New Labour, is a policy that cannot speak its name in the present party.
Bennett's view of the NHS, like that of his fellow former Downing Street health adviser Paul Corrigan, who last week said up to 30 hospitals could be run by private firms, is not where Labour's politics are going. This appears smart politics – winning Miliband votes inside and outside the party. The polls put Labour 30 points up on the NHS issue. Like his new policy guru, Harvard teacher Michael Sandel, the Labour leader thinks healthcare profits "might degrade the goods at stake". Whether it's smart policy, only time will tell. The Guardian
With the arrival of the NHS commissioning board, the biggest quango ever created, with direct control of £25bn, the health service has entered the age of Davids. While much has been made about how tightly Jeremy Hunt, the new health secretary, will embrace the private sector, real power is now in the hands of three mandarins: David Behan at the Care Quality Commission (CQC); David Bennett at Monitor and Sir David Nicholson at the board.
Of these, Nicholson, with an impeccable NHS pedigree, is the most important. He is not, in the parlance of former health secretary Andrew Lansley, one of nature's "liberators". By reputation, he remains an arch-centraliser, preferring to run things from the impregnable heights of power. As the commissioning board will oversee GPs – and the £60bn they will spend – the future will be a trial of strength between a giant board and thousands of family doctors across England.
Lansley's gamble was that the 8,000 GP practices would prove impossible to police with the zeal of a political commissar. However, so far, Nicholson has proved able to impose his view on the service – for example, ensuring private companies don't do any of the commissioning for GPs. He will also pop up if a clinical commissioning group goes bankrupt – to ensure failing partners will be made accountable. The Treasury, it is said, was particularly keen to have someone at the board with a firm hand on the tiller.
All this is important because GP commissioning is the one policy Labour's health spokesman, Andy Burnham, and the coalition can agree on – with the role of the CQC and hence of Behan clouded by the Francis report into the Mid Staffs debacle. Labour's health policy has come under close scrutiny this week. Much has been made of the apparent confusion between the call from Burnham to "repeal the Health and Social Care Act" and Labour leader Ed Miliband's claim not to "reverse it all back". In fact, Miliband and Burnham are on the same page, although reading from different parts of it. What Miliband appears to be against is turning the NHS into a regulated industry, operating under rules set by Monitor – the new economic regulator.
The coalition thinks the NHS should become more like the telecoms or gas industry. Lansley, a former civil servant who piloted privatisations in the 1980s, knows the arguments well. He's been making them since 2005.
Labour's policy is bad news for Bennett, the Monitor chairman, who had been a senior partner at McKinsey and head of the Downing Street strategy unit under Tony Blair. Bennett nailed his colours to the mast in early 2011 when he said: "We did it in gas, we did it in power, we did it in telecoms … We've done it in rail, we've done it in water. So there is actually 20 years' experience of taking monopolistic, monolithic markets and providers and exposing them to economic regulation."
This doesn't sit easily with Burnham's "one budget, one system" mantra for Labour's NHS. The creed of competition and choice, which fell so easily from the lips of New Labour, is a policy that cannot speak its name in the present party.
Bennett's view of the NHS, like that of his fellow former Downing Street health adviser Paul Corrigan, who last week said up to 30 hospitals could be run by private firms, is not where Labour's politics are going. This appears smart politics – winning Miliband votes inside and outside the party. The polls put Labour 30 points up on the NHS issue. Like his new policy guru, Harvard teacher Michael Sandel, the Labour leader thinks healthcare profits "might degrade the goods at stake". Whether it's smart policy, only time will tell. The Guardian
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