As the health secretary is heckled down by nurses, and other ministers preside over a continuing 'omnishambles', Cameron needs to get a grip on his government
Back in April 2011, the government paused the development of its health policy and outsourced it to a group of people it brought together over a weekend. At about the same time No 10 let it be known that the prime minister had made a strategic error when he came into power eleven months earlier, by explaining how he as PM would lead the organisation of the government.
Famously he had said that when he came into office he intended to be the chair of the government and not its chief executive. He had thought that as chair you could appoint competent executive directors and let them get on with the hard work. In this case he would chair the cabinet and his cabinet ministers would get on with running the country.
Last April, it was the failure of his health secretary to explain and develop the government’s health reform policy in a coherent way, that led David Cameron to let it be known he was going to become CEO of his government. To assist him in this process he appointed a number of staff as special advisers to help him with this more arduous task.
Over the year since, those of us interested mainly in health policy have not felt that a noticeably surer hand was at the helm of government policy in this area. In June and July 2011, and later in February 2012, the prime minister became animated about his government’s NHS reforms. However, as was said to me at the time, he kept coming on the field of play as a substitute secretary of state. His aim was to help his team out, rather than to play the captain – on the pitch all the time.
By the end of March 2012 the Health and Social Care Bill became an Act, and whilst the PM knew that one of its aims was to give front line medical staff more say, one never formed the impression that he really knew what was going on in the detail of his policy.
In recent weeks, as what correspondents now seem to be calling the 'omni-shambles' of the Budget has layered bad news upon bad news, we have heard once more of Cameron's intention to be the CEO of the government and not its chair.
(It’s interesting to note that this intention to work a lot harder to run the country is now used by the prime minister as a sort of annual Spring resolution. One he makes every year, only to forget about when the long evenings beckon and someone comes round asking if he will come out at five o’clock to play tennis in the sun. All the good resolutions to 'buckle down' and spend the evening working out which set of fighters to buy for our aircraft carriers seem to fly – unlike the fighters – right out of the window when there is something interesting to do).
Last Thursday, the Financial Times published a leader about this phenomenon. As the FT notes, this year’s promise to get a grip on government policy is too late for NHS reform, but it would be useful if there was some coherence about all other aspects of public service reform.
Paul Corrigan was formerly senior health policy adviser to Tony Blair when he was prime minister. A longer version of this post first appeared on Health Matters
