What Commons health committee chair Stephen Dorrell said to HSJ last week was not symptomatic of a tiff between him and Andrew Lansley. More significant issues are coming into play.
The first is about government priorities. Item one on Dorrell’s NHS agenda is not restructuring. Regardless of whether we view abolishing primary care trusts as a means to an end or as mere displacement activity, restructuring is always with us. It is the way public sector bureaucracy adapts to strategic change. The quangos that comprise the NHS will always be transient.
No: the priority, given the wider economic context, remains that “Nicholson challenge”. A cool £20bn please, by 2014. Productivity, productivity, productivity. No slacking.
Performance management within government is a legitimate enough role for a parliamentary committee, and Dorrell appears to be taking it on with some relish. When a major department of state pursues serious change, it is reassuring to have mature pairs of eyes running through the plans and the financials in more or less real time, examining progress, and checking for slippage.
It is especially reassuring for HM Treasury - so it is helpful Dorrell’s committee will now be scrutinising spending estimates.
The second big issue appears to be parliamentary, rather than ministerial, control over public expenditure. This is what mutterings about “lack of accountability” within the proposed new commissioning regime are really about. Anyone can blow a budget. Really serious problems arise, though, when systems and controls are too weak, or the financial culture too lax, to know when the budget is being blown.
Sceptics may view this as Treasury control in another guise. So the secretary of state plans to place £80bn of the health budget under the control of, um, whom, exactly? GP consortia that don’t actually exist yet? And which don’t even have provisional boundaries or governance regimes?
Prudence was at the Treasury long before Gordon Brown, and she hasn’t yet been pensioned off.