20 June 2003
In the hothouse atmosphere of Whitehall, secrets have a habit of leaking out. Not so Alan Milburn's resignation as health secretary last week. Even his old sparring partner Gordon Brown was said to have been unaware of Milburn's decision to spend more time with his young family.
The reaction to the announcement has been one of sympathy – the British Medical Association says doctors would empathise with his decision to get a better work-life balance – and plaudits for his efforts.
NHS Confederation chief executive Gill Morgan's comment is typical. 'I am sad to hear of Alan Milburn's resignation. His true passion about the NHS shone through every time he spoke about it. The health service will miss his powerful support and advocacy,' she says.
Milburn was the driving force behind Labour's NHS modernisation programme. Yet if he was the architect, his successor John Reid will be cast as the builder of the new health service. When Reid was told he was moving to health, his reaction was to utter an expletive. But he will not shirk from the job at hand.
Reid, known as the prime minister's Mr Fixit following a spell picking up the pieces of the Northern Ireland peace process, will have the primary task of implementing Milburn's plans. Few believe he will be developing policies of his own.
The NHS will be hoping this is the case. Not only have there been several overhauls of the structure since 1997, but further significant reforms are on the table. These include pay modernisation, greater use of the private sector, patient choice and the introduction of foundation trusts.
'The overriding priority of the new secretary of state should be to ensure a period of stability so that staff have the space and time to deliver this agenda and get on with improving patient care,' Morgan says.
She will have been heartened by the noises emanating from the department this week, which insisted Reid's appointment would make no difference to the implementation of the government's policy. This is despite virtually a complete overhaul of ministers at the department, where only John Hutton remains from Milburn's team.
Reid may welcome some relative stability as he faces tricky challenges in implementing his predecessor's reforms. In his in-tray there will be a decision on franchising the management of three no-star trusts and whether to hand a franchise to the private sector for the first time.
Staff pay will also top his 'to do' list over the coming weeks.
The Agenda for Change reforms for non-medical staff have effectively been put to bed until early next year, as the changes are to be piloted. And it seems GPs are poised finally to accept a new contract when polls close on June 20.
However, the row over consultants' contracts is still live and Reid's appointment could allow both the government and the BMA to reach a compromise without losing face. The association is expected to demand a meeting soon.
As with Reid's predecessor, foundation trusts threaten to take up much of the new health secretary's time. Opponents have been handed a new front on which to fight. Reid is a Scottish MP and there will be no foundation trusts in Scotland – so he faces accusations of implementing a controversial policy that will not affect his constituents.
King's Fund chief executive Rabbi Julia Neuberger believes a 'short pause' is needed to examine all elements of health policy, including the foundation initiative. 'Foundation trusts need to be piloted and evaluated before being rolled out nationally,' she says.
'In principle, locally accountable health-providing organisations are the way forward – but attention needs to be paid to the models of organisation and the detail.'
John Reid comes to the Department of Health with the reputation of being a doer rather than a thinker. He will need to call on all his powers if he is to implement Labour's agenda and fulfil the prime minister's promise of making significant improvements to the health service in time for the next election.
PFjun2003
