What is the role of the Secretary of State for Health? What should it be? How far, in an almost e...
Which Secretary of State had closed ‘more hospitals than people had hot dinners’? And which said he ‘had no problems with command and control’?
The Health Foundation, an independent health care charity, has launched today Glaziers and window breakers: the role of the Secretary of State for Health, in their own words, by Nicholas Timmins and Edward Davies, featuring ten interviews with former Secretaries of State for Health, from Kenneth Clarke to Andrew Lansley.
In addition to the insight, wisdom and advice of the ten who have performed what has been dubbed by one of them ‘the toughest job I ever had’, the book contains thorough analysis, by Nicholas Timmins on behalf of the Health Foundation, of their words and the landscape in which they had to operate.
The main messages from Mr Hunt’s predecessors were:
- There is an inescapable overlap between politics and the management of the NHS. Different boards, executives and laws have tried to give a structure to the relationship between the two, but one of the key challenges is recognising and deciding what is in the scope of the politicians and what is in the scope of the service. Different incumbents have taken wildly differing views as to the extent of the overlap, but there is overall consensus that politicians should not try to ‘manage’ the NHS.
- Regardless of where you have come from, the Department of Health is different. It has a different culture, different structures and different demands to any other department. From the unusual relationships at the top to the complex arrangements involving a statutorily independent commissioning board, a set of regulators and other arm’s-length bodies.
- The NHS is also different to any other part of the public sector: it is at or near number one in the list of public priorities; much of the talent and knowledge about care is on the clinical front line, with the associated political power; and it carries out very high-risk activities. For these reasons, the NHS is never far from the headlines.
The book was named after a quote from Virginia Bottomley (Baroness Bottomley of Nettlestone), where she said ‘Sometimes you want a window breaker and sometimes you want a glazier. Ken was a window breaker and he was brilliant. But after that you get William Waldegrave who was a glazier… And then a new set of problems will arrive and you need a Ken to break the windows again’. It highlights the fluid and ever-changing nature of politics and how it can and probably does dictate the role of the Secretary of State for Health.
Dr Jennifer Dixon, Chief Executive of the Health Foundation, said: 'Imagine you are appointed to a very high profile and powerful job, covering the riskiest organisation in the UK that you haven’t worked in or with before, with no job description, no appraisal, and a top team you have limited powers to select? Welcome to the world of the Secretary of State for Health in England. But help is at hand: Glaziers and window breakers offers frank insights from ten previous post holders on traps to avoid and possible shortcuts to success.
'While personality tends to trump rules, there is also surprising consensus on how to steer the NHS. The book is critical reading for all who are serious about the future of the National Health Service, as well as a most human and amusing record.'
Nicholas Timmins, co-author, said: 'There is no handbook on how to be Secretary of State for Health. Nor can there be. But anyone aspiring to or landed with the office - and who found the time to read these interviews with the ten former holders of the office - would, at the very least, be forced to reflect on the job and on how they might go about it.'
Thais Portilho, Senior Public Affairs Manager
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Notes to editors
Nicholas Timmins is a senior fellow at the Institute for Government and the King’s Fund. Between 1996 and 2011 he was public policy editor of the Financial Times. He is also a visiting professor in social policy at the London School of Economics, and at King’s College, London in public management. He is a senior associate of the Nuffield Trust.
Edward Davies joined the Health Foundation in September 2014 as a Policy Fellow. Edward has spent the majority of his career working as a health journalist. Most recently, this saw him working as a North American Editor for the BMJ and, prior to that, writing for a range of trade and general publications from Medeconomics to the Guardian.