Published: 07/03/2002, Volume II2, No. 5795 Page 13 14
Malcolm Chisholm is a consummate politician.
During our interview, the last thing he said as he snatched up his anorak to leave for his next appointment was: 'How's your dog?'
This was a reference to a recent incident in which Scotland's health and community care minister (then deputy) saw me walking up the road with a greyhound, out of whose backside was hanging, not to put too fine a point on it, a sock, which had been swallowed and then lodged in her bowel, rather dangerously, as it happened.
A vet bill for£1,100 was made sweeter a few days later when the minister - despite being a selfconfessed non dog-lover - rang up for a condition check.
Mr Chisholm has been employing that same eye for the detail that is bound to please since taking over his current post at the end of last year. Almost immediately, he embarked on several populist - and popular - initiatives which seemed to suggest that he was trying to get in the good books of as many people as possible.
He stepped into the simmering row over the Beatson oncology unit in Glasgow, which was beset by the resignations of consultants, who cited lack of resources and remote management.
Then, faced with a salmonella outbreak in one of Glasgow's crumbling hospitals, the Victoria Infirmary, he immediately ordered new standards on cleaning and infection control.
When the Scottish National Party accused NHS Scotland of fiddling the figures by closing waiting lists, he again acted fast, asking Audit Scotland to investigate (and taking the chance to re-announce a new central waiting-list unit to tackle the issue).
And only last week, he drew an audible gasp, then a spontaneous round of applause, when he told a nursing convention that there would be a nurse on each NHS unified board, cleverly forestalling one of the nursing unions' biggest gripes.
Asked last Thursday, however, how his first three months in the job have been, he smiles and says simply: 'It is been very hectic.A lot of the issues which have presented themselves have actually concerned our priorities, such as cancer services at the Beatson, closed waiting lists, delayed discharge and so on. These were already concerns, but events have reemphasised them.'
He says: 'You can turn crises into opportunities. Sometimes when something bad happens, it highlights the need for action.'
One of the biggest 'opportunities' was the situation at the Beatson, which appears at last to be turning the corner with the promise of new resources, to be spent in consultation with the clinicians.
But does Mr Chisholm's decisive action in stripping the unit away from North Glasgow University Hospitals trust, putting in new management and making it the direct responsibility of the health board, indicate a more centralist attitude?
'There is a tension between centralising and intervention and empowering local staff to get on with it, ' he says. 'We are going for escalating intervention to provide support where there is a real problem.'
He says that government intervention in the case of the Beatson is not to be seen as a precedent suggesting that the heavy hand of government will fall on any trust with a local problem. But revealingly, he adds: 'Where There is bad management, You have got to be prepared to intervene. There is been unfair criticism of us being centralisers - for example, with the waiting-list unit.
But it is already working, with the first patients going between Tayside and Fife last week, for endoscopy, for example, to shorten the waiting times.
'I think the new democratic legitimacy of the Parliament means it is right for the centre to set standards, for example, and expect boards to deal with national priorities. But I also expect the real leaders to lead locally, and That is the doctors and nurses.'
Mr Chisholm is full of praise for clinicians.He wants to 'free' them and give them the 'flexibility' to redesign 'front-line' services. He is also hot on the idea of the patient voice, stressing that staff and patient needs are not mutually exclusive.
But when it comes to managers, he is less fulsome. They will be held to account through the new performance assessment framework. They will have to show that they are spending money in the way he wants - on priorities such as mental health, for example. He cites new moves on delayed discharge, where local authorities and health services will be given resources firmly tied to dealing with the problem. 'None of that money will leak away and be spent on anything else, ' he asserts.
Mr Chisholm seems reluctant to be drawn on whether NHS Scotland is likely to face more upheaval. Since the new unified board system began in October, there has been speculation that more change is on the way - most likely culminating in the end of trusts.
'That is backburner stuff, ' he says. 'People are obsessed with structures.We have a group looking at the future of management, but that will all be post-election.'
There is already scope within the existing system for innovation, he says, adding that local healthcare co-operatives (LHCCs) are making significant developments without legal changes. But he hints at what is to come when he adds: 'With LHCCs, it always seemed very odd to me that they didn't have statutory powers.'
When reminded that in some areas of the country - Argyll and Clyde, for example - LHCCs have complained that they have not been given their rightful share of cash, which all has to be directed through the health board, he claims quickly that this has been addressed.
'We have a lot of power over boards, 'he asserts, without spelling out how the Scottish Executive can force a statutory body to give cash to a non-statutory body.
Leaving structures aside, one of the biggest bugbears to face the minister since he took over from his former boss, Susan Deacon, has been use of the private sector. Compared to England, Scotland's private sector is marginal, with around 900 beds in total.While Mr Chisholm and others have tried to emphasise its limited role, certain quarters of the Scottish media have repeatedly taken him to task for not making it a central part of NHS reform.
'We are very clear that we'll use spare capacity, ' he says wearily.
'But we will not back anything that is detrimental to the NHS. If the private sector were to expand, that could have an effect on NHS recruitment, for example. That is not our policy.'
Asked if he fears that the growing practice of English trusts buying up spare capacity in Scottish private hospitals could lead to independent sector expansion, he is reluctant to answer. 'I like to keep out of English issues, ' he says.
Equally, he will not be drawn on whether it was Whitehall pique which led to the Department of Work and Pensions' refusal to top up personal care cash with attendance allowance which would previously have been paid to Scotland's elderly people.
'That is all water under the bridge, ' he says (but with a glint in his eye which suggests that work and pensions secretary Alistair Darling will be off his Christmas card list).
Or maybe not. For Mr Chisholm has shown he is nothing if not conciliatory - in style, at least. But he is no soft touch. Those in his department who thought Ms Deacon's departure might mean less nit-picking have been disappointed. Apparently he is just as difficult (in a good way).
And remember as well, in these days when it seems impossible to persuade a politician to resign, that Mr Chisholm was the first of Tony Blair's ministers to do so, in 1997. That was on a matter of principle. He couldn't stomach cutting benefits to lone parents.
And the dog? She is fine.
And she is kept well away from socks.
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