Why ministers are walking an NHS tightrope

Man on tightrope The next few months could be crucial for the government in terms of the NHS

In his evidence to MPs, NHS chief executive Sir David Nicholson described the current moment in time as one of "maximum risk".

He was talking about the health service, but the term could equally be applied to the government.

It is easy to forget that just over a year ago ministers were fighting to save their health reforms - and perhaps even the coalition itself.

As Sir David pointed out as he was grilled by members of the Health Select Committee over his handling of the Stafford Hospital scandal, the coming weeks will see the whole structure of the health service redrawn.

More than 160 organisations will be abolished and another 200-plus will be created in their place, including the NHS Commissioning Board, which Sir David will run.

Come 1 April they will take charge of the health service in England with its budget in excess of £100bn and workforce of 1.3m.

Reorganisations on such a vast scale are never easy.

As Sir David testified on Tuesday, the risk is that as they happen - as in 2005-06 when he was in charge of the health authority that oversaw Stafford - eyes are taken off the ball.

In one of the more revealing exchanges, he said the system at the time had lost its focus as it juggled the task of merging organisations. Patients were not put first - and that had catastrophic consequences.

Back then the reform only involved halving the number of primary care trusts and health authorities.

This time round the upheaval is much greater.


Look no further than the furore over the past week over the regulations governing procurement in the NHS for proof of how distracting change can be.

Instead of focusing on patients and introducing the changes, doctors have been up in arms about what they saw as a breach of the carefully structured compromise that won them over back when ministers were trying to get their bill through Parliament.

In return for the profession's support - or at least not outright opposition - ministers provided assurances about the extent to which competition would be pursued.

The regulations are now being rewritten.

When they are put forward again, expect them to be gone through with a fine-tooth comb.

What this all illustrates is how toxic the reforms have become for the government.

But this is unlikely to be the end of it.

Ruth Thorlby, a senior researcher at the Nuffield Trust think tank, predicts the NHS will be a highly political issue for some time.

"The combination of the disorganisation caused by the upheaval and the money running out is destined to come together to create problems."

But it also explains why in many ways Sir David is indispensable despite the calls for him to go.

As one person who has worked with him at the Department of Health says: "He is the man the prime minister trusts to see through the changes."

When the controversy over the reforms were at their peak it was not Andrew Lansley who had a hotline to David Cameron, it was Sir David.

He has been leading the health service since 2006. He has experienced reorganisation, sorted out financial problems and his presence at the helm helped reassure those who work in the NHS that the government's health policy could work.

Without him, ministers fear they will slip from the tightrope they are walking.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this

    Comment number 107.

    The NHS is built on trust:
    - in doctors & nurses, to do their best, work ethically, and blow whistles;
    - in managers (soon to include GPs), to put patients first, not budgets;
    - in strategists & planners, to structure the best services;
    - in MPs, to stop micro-managing and grandstanding; and
    - in ourselves, to challenge and praise more often.

    ... And there's not much trust left.

  • rate this

    Comment number 106.

    Sadly the more money we give the NHS the more it manages to waste. We spend a massive 9% of GDP on healthcare in the UK, compared to 11% in France, which is the world's best. Sure, we should spend more, but not on the NHS which has callously engendered a culture of incompetence, poor management and neglect for too long. How can we see the thousands of deaths in the NHS and blame funding alone? I

  • rate this

    Comment number 105.

    The NHS is a poison chalice. No Secretary of State would welcome it as his chosen brief. It's broken, it's failing, it's plagued with innefficient doctors, nurses and beaurocrats and it's an insatiable money pit.
    It will constantly bring governments, Labour and Tory to its knees.
    Break it up and start again.

  • rate this

    Comment number 104.

    Its becoming clear the whole intention has been and is to open public NHS cash to as much privatised provision as possible. One wonders why some areas of legislation were drawn up as they were & need altering. One wonders why Foundations etc have been allowed to get in debt & fail. As someone said hospitals are not in debt they are not Businesses they are simply underfunded

  • rate this

    Comment number 103.

    It isn't tricky. If the guy in charge of a hospital that is killing people says he has no idea what is going on in the hospital he is in charge of then sack him. Sack him now from supposedly being in charge of the NHS. If he can't cope with a hospital he can't cope with the whole thing. Sack him right now, right this second.

  • rate this

    Comment number 102.

    A man with No shame, No humility, No sense of responsibility and No Ideas.
    What happened to Britain, at one time being linked to even the hint of incompetence or scandal led to instant resignations.
    Governments were brought down by Impropriety and those involved faded out of site.
    Now the sit there bold as brass waffling on about fixing something the have broken as though they do us a favour.

  • rate this

    Comment number 101.

    Is this the same David Nicholson who: [..]"claimed expenses of over £50,000 a year on top of a basic salary of £200,000 and benefits in kind of £37,600 at a time when he was asking the health service to make £20 Billion cuts [...]?

    As for Ruth Thornley, I think the "peoples' think tank" will end the 'highly political' issue at the repeal of the Tories' HSC Act 2012.

  • rate this

    Comment number 100.

    I am a GP, I recently heard a valuable talk. In actual fact the NHS is performing very well. The percentage of UK GDP (I believe

  • rate this

    Comment number 99.

    98 perpetual sigh

    What planet are you on . Have you failed to read any health related item over the last 3 years .
    The NHS has been signing the death warrants of hundreds of us every day for years ,and still is .
    Tell us how to change the NHS for the better , or sit back and accept some acountability .

  • rate this

    Comment number 98.

    The government is signing its own death warrant if it follows through with these proposals. They'll be no better than the Labour traitors. No difference between killing our troops in an illegal war nobody wants, than killing our civilians via poor/unaffordable healthcare nobody wants.

  • rate this

    Comment number 97.

    The privatisation of ward cleaning is a tragedy , the deaths of thousands just a statistic .

    Good to know where NHS priorities lie .

  • rate this

    Comment number 96.

    95 spindocter

    So the policies that led to 1200 unecessary deaths at just one trust were not one step too far .
    Yet just the slightest threat of some acountability creeping into the NHS and its the end of the world .
    Again putting politics ahead of lives .
    I would rather have G4S run the NHS than anyone who has willfully ignored the careless loss of life .

  • rate this

    Comment number 95.

    You cannot sell other people'e property. The NHS belongs to every citizen of the UK and selling it would effectivelty amount to theft.

    Privatisation? selling off lucrative parts to businesses more like. The public will be left to pick up the tab with the parts that can't make a profit (basic health care no doubt).

  • rate this

    Comment number 94.

    This will be one Policy to far, the NHS is the single largest employer in Europe, and certainly the largest in the UK.
    At the next election NHS staff and ex-NHS staff will vote in their millions against this Government, the back lash across the UK will be felt in every constituency. Labour may not be fit for Government, but they will at the least Protect the NHS!

    And that is a Vote Winner

  • rate this

    Comment number 93.

    AndyDaines #4
    "When I lived in the USA I funded an insurance industry and a health industry with my taxes/medical fees. Not only was it cheaper..."

    It is not, but never mind that. I presume that you were never actually seriously ill, or you might have found that, when the insurance reaches its limit and stops paying, health bills are the leading cause of personal bankruptcy in the US. Wonderful!

  • rate this

    Comment number 92.

    No one is indespensible even if they are at the top of their profession. The NHS and infrastructure is being plunged into disasterous disorder, that may be well planned to acheive it, so the private sector can take over. He may have done well in following high commands to bring this about but he certainly hasn't been serving the public interest in all this. He should go.

  • rate this

    Comment number 91.

    WANAITT #78
    "This dog of an incompetent extreme right wing govt thinks it can steamroller its way to any reforms it likes as there is no real Opposition,"

    There has been no real opposition to any government in this country for decades, except, flawed and limited as it may have been, the House of Lords.
    Which is why successive governments have been so keen to emasculate it, and nearly finished.

  • rate this

    Comment number 90.

    The sad truth is that Nicholson didn't bring grip to the NHS financially. It was Patricia Hewitt's turnaround programme which gave Nicholson breathing room to return to the good old days of top down finger-in-the-air management.

  • rate this

    Comment number 89.

    "Usual Tory arrogance to believe they can keep "their" man in place, and ride roughshod over the wishes of the victims' familiies.
    But they WILL lose this fight eventually."

    Maybe, but not 'til they have fatally wounded the NHS, which some of them will count as the real victory.
    Unless the LibDem Grass Roots rapidly grow a spine and tell their leadership to do likewise. Fat chance.

  • rate this

    Comment number 88.

    Usual Tory arrogance to believe they can keep "their" man in place, and ride roughshod over the wishes of the victims' familiies.

    But they WILL lose this fight eventually. That is absolutely inevitable. Why can't they have the common sense to realise early doors they are on a loser, and act sensibly to diffuse the situation? Probably because they're Tories!!!


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