The Bedpan: Boris would think NHS management ‘fads’ are ‘ridiculous’

Why he matters: A former adviser to prime minister John Major and Conservative leader William Hague, Lord Finkelstein is associate editor and star political columnist for The Times. He has been a Tory peer since 2013.

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The view of Boris Johnson as a right-wing zealot is a “misunderstanding”, claims Lord Finkelstein. The Johnson family, the Tory peer explains, have always operated in the centre of British politics and he is certain that the former foreign secretary will remain in that tradition – despite his flirting with the idea of a no-deal Brexit.

Mr Johnson, he says, backs better “public spending on education [and] infrastructure”, and is “pretty open on immigration”.

Lord Finkelstein is confident that Mr Johnson agrees with him that the NHS is a “good thing” and that it does not require major reform.

“I’ve written repeatedly about how the search for an alternative funding system [for the NHS] is a mistake”, says the Times columnist. “It’s already been tried and there won’t be one. We’re much better off sticking with [what we’ve got]… and I’d be relatively confident the Boris agrees with that.”

However, Lord Finkelstein has a hunch the prospective prime minister would take the view that there are too many managers in the NHS wasting money on “being too corporate”. He would not be surprised if Mr Johnson favoured further cuts in the service’s administration budget as a way to boost the frontline.

“There’s a temperamental strand to Boris’ politics, which [finds] regulations, rules and slogans in italic fonts all a bit ridiculous.” Lord Finkelstein says Mr Johnson thinks talk of “stakeholders” and “community” consultation “hilarious.”

“I therefore think he would have a degree of scepticism about management fads in the health service, but how practical really is that? You can’t run the NHS without rules and regulations.”

At the end of June, Mr Johnson was overheard telling Tory members he intended to reform the NHS but gave no other insight on what these reforms might involve.

“In terms of new policy, I think Boris Johnson would be a strong supporter of the health service in an unreflective way,” says Lord Finkelstein, who is not convinced the former London mayor has any kind of plan for the NHS.

The NHS, of course, has a plan of its own – and its author NHS England chief executive Simon Stevens was a university contemporary of Mr Johnson. The Times columnist knew them both – and was aware they knew each other. He speculates that Mr Johnson might admire Mr Stevens aptitude and enthusiasm for political “manoeuvring” more than his rival – and former health secretary – Jeremey Hunt did.

Pushed for a health issue Mr Johnson might want to champion, the Tory Peer turns again to the would-be PM’s dislike of rules and regulations.

He thinks it “quite likely” that a government led by Boris Johnson might be in favour of the liberalisation of cannabis use.

“Strenuously maintaining a law to stop people doing something they’ll do anyway and enforcing fines on load of young people for something that’s essentially harmless, would essentially strike him as ridiculous,” says Lord Finkelstein.

He quickly adds that liberalisation would be unlikely to win widespread support within the Tory party.

In any case, the NHS is not likely to be Mr Johnson’s priority due to “all that money” the Tories have just injected into the health service. That “probably means they’ve got to look at other areas first before they swing round and look at [the NHS] again”, he says.

Another kind of PM

Lord Finkelstein has worked with three prime ministers and describes his relationships with David Cameron and Theresa May as “close”. He wonders whether Mr Johnson lacks their “immense dedication to a really large amount of decision making”.

However, that is not the only way to be a successful PM, he argues.

“There are other kinds of premiers. Disraeli was a success [and] Churchill was a success and they were both cavaliers in the same way that Boris is. And Theresa ultimately failed [at] the task she was carrying out partly because [she failed on] some of the things Boris is quite good at.”

Although Lord Finkelstein is clear the people who question Boris Johnson aptitude for the top job are right to do so, he also says the former foreign secretary is not given enough credit.

“Boris has been monumentally successful. He’s a mega-star columnist, he’s been the Mayor of London and foreign secretary and you do not do all of that by being useless.”

When it comes to Brexit – an area where Lord Finkelstein is adamant Mr Johnson’s position is a mistake – he concedes it is not inconceivable the ex-London mayor could deploy his talents to make a success of it.

“His concern for the NHS was genuine”

Lord Finkelstein points out that Mr Johnson’s rival for the top job has a track record that is even more impressive.

“Jeremy is a successful businessman, he has held three [Cabinet posts], he’s pretty good on television and is taller and better looking than Boris, speaks fluent Japanese and is still with his first wife. But people do not consider Jeremy the more dynamic and charismatic of the two candidates. That is telling you a lot about the quirky appeal of Boris Johnson.”

Lord Finkelstein thinks Mr Johnson’s stronger Brexit credentials means he will win the race to No.10.

Speculating, however, on what a Hunt premiership would mean for the NHS, he is clear the former health secretary’s concern for the NHS was genuine and that the patient safety issue means a lot to him.

“He did the thing a minister should do, which is he picked something that he thought mattered and really saw it through and that’s very important,” he says.

He suggests prime minister Hunt would do much the same. “I think he would repeat the few areas he concentrated on [as health secretary].”

In terms of how hands-on Mr Hunt would be as PM – something he garnered a reputation for during his time in the Department of Health – Lord Finkelstein cannot say for sure, but he thinks he probably belongs to the school of thought of “reacting to things as they happen”.

“The contract was not really the issue”

When discussing Mr Hunt’s legacy as health secretary, it is impossible to ignore the junior doctors’ contract dispute with the government that resulted in the first strikes for 40 years. It is an issue Lord Finkelstein followed closely.

He maintains the junior doctors were “really poorly led” and says the tactics adopted by the British Medical Association were “obviously going to fail”.

He stresses that while doctors’ working conditions should be reviewed “sympathetically”, he remains critical of the way in which the profession tried to “push out” the health secretary.

“I felt the central demand was that Jeremy Hunt should resign and they weren’t really prepared to deal with anything rationally beyond that,” he says, adding: “[The BMA] became convinced the government wasn’t willing to speak to them and I was able to establish with one conversation that was just not true. I found it very frustrating because nobody could be more worthy of respect than somebody who becomes a medic.”

Lord Finkelstein believes the dispute was not simply about the imposition of a new contract.

“There were a lot of extremely understandable frustrations within the life of a junior doctor,” he says. “Many got in touch with me and I’ve made a deliberate attempt to understand more about what they were saying. It was to do with the sheer scale of the emotional and professional pressure.”

Lord Finkelstein says he was surprised when he discovered doctors felt underappreciated.

“These are the people who are doing one of the best paid jobs with the highest status – nobody is more appreciated than doctors. It was puzzling why they were saying something patently untrue.”

However, he stresses it is important for current health secretary Matt Hancock to look at the ways junior doctors are trained and how they are supported. “You haven’t resolved these issues once you’ve simply solved the contract,” he warns.

“Ill-considered reforms”

Lord Finkelstein recalls that one of the arguments made against Mr Hunt was the “bizarre idea” that he wanted to privatise the NHS.

“The Labour party said Jeremy Hunt would privatise the NHS, that was one of their attacks on him. He was health secretary for six years. You might have thought he’d have done better in achieving that.”

Lord Finkelstein – who was a member of the Social Democratic Party between 1981 and 1990 – says that while outside the Conservative party he also believed privatisation was on the agenda. However, his first conversation with then health secretary Virginia Bottomley in the 1990s proved him wrong.

“That first meeting was with the premise, how do we make the NHS stronger? How do we make it better? How do we help the doctors? I was completely astonished by that.”

He adds that in 28 years as a Conservative Party member he has “never had a serious conversation with anyone about the idea of privatising the health service.

“This idea that all Tories are going off to Bupa hospitals in their Mercedes isn’t what is really going on”.

Lord Finkelstein is, however, critical of the “ill-considered” reforms lead by Andrew Lansley and argues it was a “big mistake” of the party to stray from a commitment of no more organisational reform.

“George Osborne, who never really liked the reforms, was concentrating on other things while they were developed and people let [Mr Lansley] do it until it was too late,” he says.

He argues the NHS did need to be reformed in order to be more productive, but ultimately the plans were not very good. “I’ve never been in favour of an independent NHS,” he said. “It’s nationally owned and, [while] that doesn’t mean I think politicians shouldn’t make medical decisions [they’ve] got a responsibility to the tax-payer.”

Reflecting on future strategy for the NHS, he says: “ I am quite small c conservative about [public] service reform. We should have more choice in public services, but you also have to recognise that every time you make changes it’s turbulent for the people who work there.

“You often end up paying a lot of money as you make someone redundant in one organisation and employ them in another. I’m not convinced necessarily changes will always justify that. So, I’m more cautious than I used to be about [reform] and I think that’s probably true of the party in general.”

Whatever, the route chosen concludes Lord Finkelstein, he and others will be looking for “a lot more professional buy in” to any proposed changes.

Next week: NHS manager turned Labour MP Karin Smyth

If there is any political or influential figure you would like us to interview, please email alastair.mclellan@wilmingtonhealthcare.com or if you are reading this on the website leave them in the comments box.

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Sir Norman Lamb MP

Staff well-being specialist David R Williams

“Super-ageing” expert Ryoji Noritake

Department of Health and Social Care permanent secretary Sir Chris Wormald

You can read all 33 Bedpans here