How to avoid blame for the underfunding of the NHS | Letters

Alan Bailey calls current governance structures unfit for purpose, while Jennifer Budden and Pam Lunn are critical of the chancellor’s response to criticism by the head of the NHS

The continuing row about health spending (Intervention by health chief meant NHS got less, 25 November) reflects the current structure of NHS governance, which is not fit for purpose. In the old days the relevant cabinet minister was unambiguously responsible for ensuring that the NHS had sufficient funding to provide an adequate health service. But, in accordance with recent fashion, NHS England was hived off as a kind of executive agency, with its chief executive undertaking a form of contract under which he was responsible for providing an adequate service. He could make representations to the Department of Health on the minimum necessary funding, but the minister would then negotiate with the Treasury and have the final say in the settlement.

If the amount on offer was inadequate in his view, then given his formal role Simon Stevens could not continue in office without making clear in public that it would not be enough to maintain an adequate service. This structure, which is now widespread in the public sector, is convenient for ministers who want to avoid responsibility for day-to-day operations in public services. But the divided responsibility promotes “small government” dogma and unaccountable power.
Alan Bailey
(Second permanent secretary HM Treasury 1982-85), London

Continue reading... November 27, 2017 at 12:30AM