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Kevin Lewis column
21st Feb 2007
Kevin Lewis contemplates how the ‘reorganisation’ of government departments does wonders for those wishing to avoid accountability. Two of the great behemoths of government – the Home Office and the Department of Health – have in recent months given a credible impression of having suffered the same fate as the stricken Napoli, the cargo vessel that recently floundered off the coast of South Devon. While the Napoli was shedding containers and oil, the Home Office has been shedding prisoners, paedophiles and illegal immigrants. Neither does much for public safety or the environment. At least the Napoli skipper knew what he had on board when he set sail, which helps when trying to figure out what has gone missing. What I have found particularly striking is the different approaches currently adopted by John Reid and Patricia Hewitt when managing their respective crises. John Reid dismisses any suggestion that there are massive problems within his department – making it clear that most of the problems are much bigger than this and that, quite probably, there are even greater problems yet to come. The finger of blame points to his predecessors, his civil servants and global factors beyond his control – but he makes it crystal clear that no blame at all attaches to him personally. Patricia Hewitt gives the impression that there really is no problem at all in her department. Hers is a health service where the sick can walk and the infirm can rise majestically from their hospital beds almost as soon as they are tucked in. It matters not that the sick are only walking because we have run out of ambulances, nor that the infirm are rising from their beds only because they are being tipped out of them either to fix bed blocking and meet waiting list targets, or so that they can get back home before they contract MRSA or C.diff. In Patricia Hewitt’s health service everyone and everything is getting better and the health of the nation is measured in statistics, targets and budgets. The other maxim of healthcare is – if in doubt, reorganise. Here, the finger of blame has shifted away from the consultants and towards the medical GPs. They – like ourselves back in 1990 to 1992 – have been far too successful in making their latest new contract work. Clearly, they must be stopped in this folly, and a way must be found to cast them as villains while the government takes credit for their achievements. I wonder if Patricia Hewitt has not quite grasped the significance of the fact that Jacqui Smith (the Labour chief whip), Hazel Blears (the party chair) and one of her own junior health ministers, Ivan Lewis, have all been on the march in their local constituencies, brandishing placards alongside their constituents and protesting against hospital/ward closures and other deficiencies in local healthcare provision. In each case, the locally-taken decisions are simply implementing government policy, and presumably the above-mentioned trio are all wholly in favour of following the agreed Cabinet policy in any part of the country, except their own constituency. Immigration has become a red-hot issue for both departments. John Reid may not know how many people are entering this country – legally or illegally – but the healthcare regulators (GMC, GDC, N&MC etc) can tell him exactly how many of the new arrivals are becoming registered to provide healthcare here in the UK. In 2005, more than 7,000 healthcare professionals of various kinds came to the UK from other parts of the European Economic Area, in addition to those arriving from other parts of the world. Interestingly enough, the Alliance of Healthcare Regulators – which includes GDC President Hew Mathewson – has recently expressed serious concerns that the freedom of movement provided for within the EU constitution is inconsistent with their statutory duty to maintain appropriate standards of professional conduct and public safety. Without a robust system in place whereby all regulatory bodies throughout Europe have a duty to share registration, regulatory and disciplinary information, healthcare professionals whose days are numbered in one jurisdiction might simply hotfoot it to another part of Europe – quite possibly, to the UK – and be free to practise in circumstances where a home-grown UK graduate might not have been. What the UK healthcare regulators are highlighting, of course, is the potential danger of fragmented and autonomous units that are not communicating effectively with each other. I hope they have also told John Reid, who has suggested that the time has probably come to consider splitting the Home Office into two separate and more manageable units. He may be right, but it is a further illustration of the ‘if in doubt, reorganise’ philosophy of crisis management, and if the civil servants within one government department cannot communicate with each other, separating them into two entirely different departments seems to be a slightly counter-intuitive ‘fix’ of the problem. Patricia Hewitt may have missed a trick here. The obvious solution was for her to split the Department of Health into 14 smaller units. One that is working outstandingly well, and 13 that are not. Then she can take her pick of which of the 14 units she wants to head up. Some would argue that Rosie Winterton is already holding two or three of these poisoned chalices. In response to a written question from an MP in South Lincolnshire, addressed to the Secretary of State for Health, it was left to Rosie – not Patricia Hewitt – to provide the embarrassing response in late January that the NHS Litigation Authority had settled negligence claims totalling about £600 million, including more than £60 million on just ten cases in a single year. And all this at a time when most Trusts are feeling their end-of-financial-year pips being firmly squeezed. Rosie will be disappointed to know that at one recent PEC meeting, the recommendation was to raid the whole of the additional infrastructure funding that Rosie announced for GDPs at last year’s BDA meeting, and to use it to meet the PCT’s own funding deficit. The plan is that none of the money will reach local GDPs and the basis for this is apparently that it is to meet a shortfall in Patient Charge Revenue and, therefore, the dentists have had the money already. In healthcare, devolving power and financial decision making from the centre to the Trusts has achieved exactly what John Reid is now proposing for the Home Office – a more diverse, not-joined-up empire where everyone can blame everyone else, promises can be abandoned with a shrug of the shoulders and, ultimately, nobody is accountable at all.
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