John McTernan: PM faces another fine mess on NHS
Who ya gonna call? Ghostbusters? Actually no, not in this case. But David Cameron has had to smash the glass and sound the alarm to save the NHS. While his appointment to run NHS England is not quite as wacky as Ghostbusters, on the face of it it’s nearly as unlikely.
The Prime Minister has had to appoint a former Labour adviser to bail him out. Now, Simon Stevens is a great appointment. He advised Alan Milburn and Tony Blair, but has also had a distinguished management career in the NHS and in the United States. But it has come to something when to fulfil his promise not to cut the NHS, Cameron has to requisition the man who saved the NHS from the Thatcher/Major legacy.
Health has been a problem that has dogged the Tories since the creation of the NHS. Conservative Party opposition to its creation was so deep, the contempt of many of its backwoodsmen towards the health service so appalling, that successive Tory leaders have had to register their own personal commitment to the NHS. Remember Margaret Thatcher’s chilling pronouncement that the health service was “safe in her hands”? In the case of David Cameron, he only got to 300 seats in 2010 because he promised to cut the debt, not the NHS.
This is existential for the PM. If his promise not to cut the NHS is broken, he will have no chance of re-election. But he has been oddly lackadaisical in his approach to health. He foolishly promised Andrew Lansley the health portfolio in government. Opposition leaders should always keep shadow spokespeople on their toes. Lansley took the unqualified support as a signal to come up with his own huge reform plan for the NHS. One which he didn’t check with his colleagues. And one which Cameron neglected to examine either.
The result? Rather like that time your brother’s mate who’s “rather good with cars” took a look at your motor. You come home and find the engine in pieces on the driveway, and a baffled bloke saying he’s lost a couple of pieces and can’t for the life of him put it back together again.
There was a story that did the rounds of the NHS midway through the Lansley reforms. Apparently, Andrew Lansley called Alan Milburn, former Labour health minister, and asked him: “What would you do, if you were me?” Milburn responded sharply: “I wouldn’t be where you are.” Pause. Then Lansley said: “I know, but what would you do if you were me?”
In the end Cameron put Lansley out of his misery, but sadly the NHS has to wait a bit longer, for not Milburn, but his adviser.
Simon Stevens may well prove to be the cure. One of the smartest political advisers, he was the brainiest adviser I worked with, and is the best health leader of his generation. But the question we should be asking is: what on Earth was David Cameron thinking?
Take a quick look around and you’ll see this isn’t a one-off. Just look at Iain Duncan Smith’s Department of Work and Pensions. I remember quizzing a No 10 staffer about Universal Credit. “Aren’t you worried it might go off track?” “Oh yes,” came the reply, “but not as worried as we are about the health reforms.” Turns out it might have been smart to be much more worried. This radical transformation of welfare, making work pay, getting people back to work and reducing administrative costs, was all based on getting real-time information on workers’ wages. Oh, and setting up a whole new government IT system. What could possibly go wrong?
Well, you and I might think quite a lot. And it’s not even our project. But if you were Iain Duncan Smith and this was the project that would define your political career, you might keep a steely eye on this one. I’d be thinking a weekly project meeting and one of my advisers on the project team. Something proportionate to the reputational risk. Instead, IDS opted for laissez-faire management. A couple of meetings over a three-year period. And when it turned out that there were some real difficulties, IDS took the coward’s route. He blamed civil servants, in particular his Permanent Secretary, Robert Devereux. Now, when I was working on welfare reform with Harriet Harman and Frank Field, I had the pleasure of working with Mr Devereux. A more imaginative, talented and diligent public servant it would be hard to find. There is no grace at all in a man who blames his staff. And there can be no respect for a politician who, embarrassed at his own failure, tries to blame, undermine and sack a member of staff. IDS promised that from October this year every new claimant would be on Universal Credit. The best estimate today is that 0.2 per cent of the case load will have transferred by the time of the next election.
Yet again, the question is – where was David Cameron? Welfare reform is an iconic project for him. But as with health reform, he has let his Cabinet minister run riot – without, apparently, any reality check. I know they are all proud in No 10 of having read Tony Blair’s memoirs, A Journey, but did they miss the section on the Delivery Unit – and the importance of having monthly meetings with ministers, with real-time data, to make sure reform is on track? David Cameron appears to believe that as PM he should be chairman of the board. And so far, to be fair to him, he has been able to talk himself out of most of his problems. But each time it uses up some political currency, each time it gets harder to jump free. One event, one failure, will be definitional. Perhaps health, perhaps welfare, perhaps national security. For the case of the escaped terrorist suspect just gets worse and worse. Theresa May’s original statement to parliament has unravelled. As fact after damning fact has emerged, she has had to clarify that the police did not have the Islamist extremist’s passport and he had form for breaking control orders.
The problems are building up for Cameron. Competence is the ultimate political currency. The voters’ perception that he looks more like a Prime Minister than Ed Miliband is based on a sense of strength, but also on a view that he can get things done. If it turns out that Cameron can’t keep his promises on the NHS, that he can’t deliver welfare reform and can’t catch terrorists, that will be a game-changer. A reputation for competence is almost impossible to regain once it is lost.
• John McTernan was political secretary to prime minister Tony Blair