Archive for November, 2009

Keeping the NHS free from politics

November 21, 2009

The former Chief Executive of the NHS, Nigel Crisp, has suggested that the service needs to be kept free from politics ( For a man of such experience, this is really patent nonsense.

There are at least two reasons why the NHS is an inherently political organisation. First, the organisation of healthcare is a political decision. If you’re American, or perhaps of a conservative laissez-faire sort of perspective, you might tend to the position that healthcare should be organised around a market-based system. On the other hand, socialists and those who think that markets have tendencies to fail in some circumstances, tend to toward the belief that the state should be involved. These are political decisions. The healthcare system that is in place is a political decision. Imagining otherwise, reducing healthcare to some kind of purely technical decision, seems astonishingly naive, as well as suggesting that those that have formerly run the service have no understanding of the problem that, as Keynes once said, we are ‘all slaves to some defunct economist.’ No matter how original we like to think we are, chances are someone has thought our thoughts before, and more importantly, was aware of the assumptions and political predilections that such thoughts carried.

However, there’s another, more important reason why we can’t keep politics out of the NHS. For goodness’ sake our political representatives our meant to be representing us – our will, what we want. As such, we are asking our representatives, our MPs, to change things in line with our preferences based on what we vote for. This observation is especially important in a general election year. Now we can argue that MPs have become disconnected with our views, especially in line with all that nonsense over expenses in the UK. However, perhaps we get the MPs we deserve. If we can’t be bothered to check them out and vote for the best people, it’s hardly any surprise that we get represented by morons as well as good public servants.

What we probably need is more politics in the NHS not less – that it comes to represent our views, and that as result, those that are involved in political decisions both have to take account of more local voices, as well as getting those local voices to participate in discussions about the future of healthcare. It is often said that the NHS is the closest thing the British have to a national religion. If we can’t get passionate about it, what political issue can be get passionate about exactly? We need to get more grown up about the way we talk about local politics, not just demanding better services for us as individuals, but also thinking about the implications of our decisions for everyone else. It is all well and good demanding that the NHS fund additional drugs, but those choices carry with them implications for reduced budget for others. These are really important decisions that we need to need to be making through debate – through the political process.

I’m of the view that the NHS needs to become more local and less national. In my book on the NHS ( I argue that we need to stop pretending that the NHS is in some way a national service and instead celebrate local difference and diversity more. We don’t expect housing or education to be the same everywhere – why should we expect the NHS to be offering the same service in Clacton and Milton Keynes, where demographics and needs are very different. This is the stuff of politics. Expecting the NHS to free from politics is nonsense. We need it to be politically accountable – far more so than it is at present – not free from politics.