Wednesday, April 22, 2009

Who Runs The NHS?

Aneurin Bevan, Labour's Minister of Health whose NHS Act of 1946 came into operation on 5 July, 1948.

This is an anonymous contribution for our discussion on 10 May with Kevin Barron MP on the NHS Next Stage Review (see details of the meeting in the right hand column opposite), posted via Harry Barnes.

Who actually runs our local NHS Trusts? We elect Councillors who run our local authority services, but who are the faceless people who run local NHS services…..?

Gordon Brown has previously dropped hints of making the NHS independent – run by some sort of ‘BBC’ type board! According to the HSJ (Health Service Journal), top NHS managers at the DH were, at one point, running around preparing (I think enthusiastically) for such a scenario. Unsurprisingly doctors leaders are supportive of this idea! Doctors like to be in control, and a political vacuum leaves local health services free for domination by the medical mafia. Today the NHS is in the clutches of right wing ideologists, accountants and those who swarm around the alter of ‘lean thinking’, labour has given up the vision of a socialist health care system, and sold its soul to the marketers and profiteers.

Talk by the Tories too of taking the politics out of the NHS would be hilarious if it wasn’t so serious! But this must be music to the ears of the many right wing zealots who current dictate NHS policies.

For a Government committed to ‘democracy’ and de-centralisation, since labour came to power in 1997, it does seem ironic that the NHS, Labour’s jewel in the crown’, is having the last vestiges of democracy stripped away.

As a closet socialist working in a very senior role in an NHS Foundation Trust, I have had plenty of time to get used to the snide comments, and cynical ‘stage-whispers’ of senior NHS managers, who laughingly pay lip-service to Government policy, yet they are inherently anti-labour! What makes it even more disheartening is that the view often expressed is that Labour Ministers simply do as they are told by the DH Civil Servants. The NHS is so full of ‘inner-circles’ of NHS Chief Executives and Civil Servants, who were all nurtured in the Tory period of mass privatisation, marketisation and mass job cuts. It is very clear to me (as an insider) that it is these ‘inner-circles’ who are driving the pace of marketisation (we have to call it by the sanitised name - “Contestability”)

When NHS Trusts were established by the Tories in the early 1990’s, they removed the split between the Health authority members (a rather odd mix of ‘do-gooders’ Local Councillors and a single TUC Representative), and the non-voting Executives. The creation of Boards of Executive and Non-Executive members with the Chief Executive and Finance Director having the same vote as the ‘appointed’ non-executives.

Looking at the lists of non-executive directors in NHS Trusts, there are not many who sound remotely like labour people, and, although many of them declare ‘no political affiliations’ their backgrounds and histories make some interesting reading. Take the most recent appointments of Chairpersons for the new and enlarged (Regional) Health Authorities. We have a former Second Sea-Lord, a former employee of BUPA, a former Executive of privatised rail companies, and someone who holds directorships in the pharmaceutical industry and the financial services sector.

Vast numbers of ‘Labour’ supporters or sympathisers are excluded by virtue of the prejudiced and biased person specifications set for the role of non-Executive Directors or Chair’s. Language such as “Business” level experience, “Finance or Accountancy” “Entrepreneurial skills”, “Commercial”, or must have “Board level” experience are often seen in adverts. For Foundation Trusts, and it appears, for most NHS bodies, even the requirement to live locally has disappeared! What would be wrong with “Experience as a patient or service user”? or “Aspires to represent the local community” or “Be prepared to challenge the Chief Executive or other Directors on key policy issues.

What we have, in reality, is NHS Trust Boards stuffed full of Tory leaning, right wing, business people, who are keen to earn their £6K (for a non-executive) or £20/60K for a Chairperson) and vote like puppets as per the recommendations of the ‘Executive team’. Many foundation trust boards now meet in secret with only a small number of meetings being open to the public. The abolition of Community Health Councils leaves yet a further gap in local accountability, with local authority scrutiny panels trying to pick up the pieces.

Foundation Trust ‘Governing Councils’ are another sad example of what is happening to the NHS. I am a senior manager in a foundation trust, so I can tell any aspiring Trust Governor – ‘ don’t waste your time’! The Chief Executive and the Chairman may pay lip service to the Council, but behind your backs they are sniggering away. No power…. And no real purpose, except to provide a ‘pretext’ of democracy and accountability.

The debates in the labour Movement in the 80’s and 90’s, led by health unions and the socialist health association around the principle of democratising the NHS, often resulted in overwhelming votes in favour of democratically elected health organisations at local level. Sadly it seems that Schools are to go the same way (Foundation Schools/ Foundation Trusts) put a few business people in, remove local elected representatives and screw democracy! Under a Labour Government! Call it ‘choice’ (patients or parents) but it is really about a ‘Hobson’s choice’ for the many, and an offer of choice only to those who have informed knowledge or money. For me, I choose my local community hospital, my local GP and my local school.

I campaigned hard in 1997 for the election of a Labour Government (so hard I was thanked personally by Tony Blair, in 10 Downing Street, for my efforts) part of that campaign was to remove the vilified ‘internal market’. But what we have now is no different. For ‘purchaser/ provider’ read ‘commissioner/ provider’! For Fund-Holding GP practises, read GP commissioning! My Trust spends tens of thousands of pounds on clinical coders – whose job it is to cost each element of treatment to ensure we get the right invoice to the PCT or GP! The local NHS services are so wound up with unnecessary bureaucracy that it is no wonder patients are left wondering where all the money is going!

It seems to me that the army of young graduate ‘advisors’, who I saw following the then ‘shadow’ cabinet members around on the election campaign, have spent the last 10 years nurturing the seeds of right wing ideology in the corridors of power. Why else are we still exposing ‘dirty hospitals’, when most hospitals are still suffering the consequences of privatised cleaning services. My own hospital is a prime example – poor standards, low pay and very dubious employment practises!! Simple answer is bring services back in house! Seemingly more difficult than it sounds – but I don’t understand why?

The NHS is political, and no government can pretend to ‘take politics’ out of its governance. The issue should be maintaining the balance between national standards, and fair funding, with local accountability and local democracy.


  1. Hi Harry, if you are still there its all an illusion, democracy thats just a word to make people feel apart of the system make them feel they are in control. its all about money, power. would like to know more of your thoughts as you have only just touched the surface. the nhs is just a market for money making.

  2. Anonymous : I did not write the above item. From the opening sentence you will see that I posted it from someone who wishes to remain anonymous! But here are my thoughts.

    I feel that we are a lot better off with the NHS than we would be without it. What we hold needs defending, but it also needs extending. It should be democratised, not by running internal markets and having meaningless choices when we are ill, uninformed and in the urgent need of treatment. Instead let us have intelligent debates in society about how the NHS should operate and use our votes and voices to see that we get what we want. We can then set up local avenues for having a democratic input into our immediate NHS operations. One of the things we need to decide to do is to get rid of Private Medical Services. Private provision messes up the NHS framework in which consultants and others operate.

    Democracy given a population that knows how to use it (another big problem to resolve) is the best way to remove the power of monied interests.