The NHS is improving—but government must resist the urge to manage from aboveby Julian Le Grand / June 25, 2006 / Leave a comment
Patricia Hewitt was right. This has been the best year the NHS has ever had. More patients have been treated than ever before—and treated both faster and more effectively. Survey after survey shows that those who have recently used the NHS think it is getting better. Staff have not done too badly either. There are more nurses than ever before: 85,000 more since 1997. Entry-level nurses’ pay has increased by 25 per cent in real terms. Doctor numbers have increased by over a third, and, as we all now know, their pay has also shot up. Even non-professional staff have seen substantial rises in pay.
So why all the fuss? Why was Hewitt shouted at by the nurses, told she was on another planet by the press and disbelieved by the general public? Partly it was because of the accumulating stories of hospital deficits and job losses. But even these don’t really explain the manure that has been dumped over her and the government’s heads in recent weeks.
The deficits—less than 1 per cent of total NHS spending—are trivial, the sort of sum that gets lost in the accounting noise of a large corporation. Moreover, if they are set against an underspend on capital last year, the NHS as a whole is in surplus.
The job “losses” are also tiny, relative to the NHS labour force of 1.3m. And most of them are not in fact real losses; they are decisions to freeze recruitment to unfilled posts and not to take on more agency staff.
One factor behind the hostility to Hewitt at the union conference she was addressing is inter-union politics. Unison and the Royal College of Nursing are both in the market for members. Running down the service you work in is a sure way to make yourself popular in the public sector. So it is not surprising that, as we have previously seen with teachers, public sector unions compete over who can best shout down the secretary of state.
But none of this fully explains the sense of malaise that infects the NHS—and other areas of the public sector. It reflects something more fundamental: an accumulated resentment by staff of being pushed around and having their autonomy threatened.
The resentment has several sources. Partly, it is the process of reform itself. Many feel, rightly or wrongly, that they have not been consulted, while those that have…