One less health minister: how the government can lead by example

There can be too many political agendas in healthcare, David Cameron told a Number 10 reception for the leaders of the NHS England vanguard projects last week. The prime minister promised that he had just three: integration, seven day services and scientific innovation.

The PM was then followed by Jeremy Hunt who told the audience that what the NHS usually wanted from a health secretary was “money and silence”. He claimed that money would be forthcoming in the following day’s comprehensive spending review and, while not promising “silence”, said he would seek not to add significantly to the NHS’s to-do list.

A couple of days later the CSR revealed huge cuts to the Department of Health’s budget to help fund the increase in NHS England spending.

Cutting interference

The decision gives the PM and Mr Hunt a perfect opportunity to demonstrate their commitment to keeping government interference in the NHS to a minimum while leading from the front on efficiency.

‘Ministers generate both effort and cost as they go about their work’

At present the DH has five and half ministers, with George Freeman being shared with the Department for Business, Innovation and Skills. Ministers, perfectly understandably, generate both effort and cost as they go about their work. The Department is facing a reduction in its budget of about 20 per cent and it would therefore makes perfect sense for one minister to join the hundreds of DH staff who will soon be made redundant.

This suggestion is not a comment on the quality of the DH ministerial team. Last week’s HSJ100 showed that the current crop is effective most of the time, with only one of the six not making the cut.

No doubt the comments below this piece will shout “sack the lot”, “start with Hunt”, and so on. Readers are, of course, entitled to their opinions – but this debate should not be about personalities, it is simply a reflection that a smaller department and a focus on devolution requires less national political leadership.

Proportionate and appropriate

The appointment of ministers - and therefore their number - is, of course, the purview of the Prime Minister. However, no doubt he will be very intrested in the views of the health secretary and DH permanent secretary Dame Una O’Brien as they develop their response to the CSR settlement.

Reorganising the department with one less minister would be a proportionate and appropriate reaction to both its financial challenge and a desire to give the service greater local autonomy.