The Conservative manifesto is full of promises on health that only government can deliver – and they have their excuses at the ready if they fail to, argues Paul Corrigan
Famously, the prime minister likes to tightly control things. Less famously, when she was home secretary, and together with the rest of the cabinet, she voted to ‘liberate’ the National Health Service from government control through the Health and Social Care Act 2012. This act that she voted for on many occasions, separated the control of the NHS from the government’s department of health into its own quango with a chief executive who was not a civil servant. At the time most of us involved in the NHS thought this an odd thing for a government to do since the public are clear that they think the government is accountable for the NHS and not a bunch of quangos.
This dual approach to accountability can be found in the current Conservative manifesto. On occasions of risk the NHS is in charge. On occasions when the Conservatives want to make an electoral promise the Conservative government will be in charge.
So, even if rather ominously for the NHS leadership, ‘We will hold NHS England’s leaders to account for delivering their plan to improve patient care.’ Here clearly the quango NHS England is in charge and the government is merely holding them to account on behalf of the public.
The rest of the document however makes assumptions that only government can achieve. To give a few examples:
- ‘We will ensure that the NHS has the buildings and technology its needs to deliver’
- ‘We will ensure that the NHS and social care system have the nurses, midwives doctors carers and other health care professional that it needs’
- ‘We will continue to rectify the injustice suffered by those with mental health problems’
- ‘We will improve the care we give to people at the end of life’
From these promises it is clear that it is ‘we, the Conservative government’ will do these things. And yet, ‘we, the Conservative government’ passed an act that created a number of quangos that will achieve them or not.
If, for example, by 2022 the NHS does note have the nurses midwives and doctors that it needs, the Conservatives will be likely to say that the quango they have set up – Health Education England – is responsible for the failure.
Each of these promises has a quango to blame if they are not met. Yet the promises are made by a Conservative ‘we’.
This confusion of accountabilities underlines the suspicion that many of us held – that the government did not know what it was doing when it passed the Health and Social Care Act.
Given the importance of the NHS to the life of the nation, this is more than a nerdy policy issue. It is at the heart of what our democracy means. Every member of parliament’s surgery contains constituents’ issues about the NHS. MPs regularly promise to ‘raise this issue with the secretary of state for health’ because the public assume that government and parliament are accountable for the NHS.
Passing a law to change that accountability for the NHS to a number of quangos has had very little impact on who the public want to hold to account for the NHS – its government and parliament.
The opinion polls predict that the Conservatives will be enacting this manifesto as the next government.
If in 2022, the NHS does not have the doctors and nurses that it needs, if people with mental health difficulties still suffer injustice and if the NHS does not have the buildings and technology that it needs, it will not be a bunch of quangos that the electorate hold to account, it will be the Conservatives.
Paul Corrigan was a health adviser to the Labour government. He tweets at @Paul_Corrigan
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