Published: 13/12/2001, Volume III, No. 5785 Page 11 12
The health secretary has had a very long, hard day. He has announced next year's funding allocations, fronted a major debate on the health service in the Commons, joined Microsoft chief Bill Gates at an IT conference and shared a joint press conference with the prime minister on patient choice.
And It is not over yet. So before his interview with HSJ, Alan Milburn grabs a few minutes on the phone to his children, before bounding out of a side door singing Annie's Song and loosening his tie.
He professes to be exhausted and collapses on the sofa in his office. In fact, he appears fit and well - but then most people would compared with Tony Blair, who he has spent the previous hour standing next to.
He sits up, straightens the tie and summons up those last reserves of energy to explain just how well the NHS in 2001 is doing and just how much it has still got to do.
Mr Milburn knows his message has to strike the right balance. So it is thanks to everyone working in the NHS for all their hard work so far - but now it is time for more action - and fast - to make sure the general public sees the government is doing what it promised to do for public services.
And so he starts by saying that running the NHS is the 'biggest management challenge there is, not just in this country but anywhere' and straight away says he cannot understand why managers are so defensive 'because nobody's saying that people are crap'.
He insists that the NHS can't defend itself against the criticisms about things like long waiting times, but equally he exhorts all those working in the NHS to stand up for the service because it is up to them to do that and there are not too many others who will.
On star-ratings in particular, he is 'alarmed' that the reaction is for people within the NHS to become defensive when people outside have an absolute right to know how their hospital is performing.
Mr Milburn knows a million more voices wouldn't do any harm in trying to remind people what is good about the NHS, and there is no doubt that the health secretary himself is passionate about the service.
His manner is jovial and relaxed, his speech peppered with endless 'you knows' and 'reallys'. But he takes on an almost evangelical tenor when the subject is his belief in a state-funded health service:
'The NHS is in my blood. I care about it absolutely. Fundamentally, it is the right way.'
But he is well aware that his passion for the NHS - 'though not as It is always been' - is not universally shared, and he notes that 'conservatism, with either a small or a large 'c', has never been a friend of the NHS'.
He knows, too, that the general public have got to start seeing results from the much-publicised reforms and so he also warns that 'time is just not on the NHS's side - people really need to understand the impatience of the public mood'.
There are a few 'simple and straightforward' things the government expects of the NHS, Mr Milburn insists, such as reduced waiting times, and in return money is starting to flow through the system. And - whether or not front line staff realise it - the number of targets and the amount of ringfenced money is starting to be reduced.
In the end, this health secretary wants to see an NHS that is managed at local level rather than centrally - not the state enterprise it was, but responsive to local needs.
Part of that means giving staff who provide the best services the freedom to do things their own way.
For example, chief executives of three-star trusts will be coming to talk to him next week about their ideas for playing their part in this very different service, with very different relationships. On this concept of earned autonomy, which is obviously close to his heart, he becomes more animated. 'People had incentives in the past - but they've been the wrong ones, ' he growls. 'If you're a bad hospital, you get more money. If you're good, you get nothing. The good manager complains because the bad manager is bailed out.'
And asked how earned autonomy might develop and whether he was waiting to see what former Confederation of British Industry director-general Adair Turner has to say in his report on the NHS for Mr Blair, he bristles: 'We are not passive recipients of policy.'He pulls his shoulders back. And then he relaxes again and slips his shoes off.
There will be changes, too, to the relationship between the Department of Health itself and the NHS. The DoH of the future will have just three functions, he says - to set national standards in conjunction with clinicians and patients, to distribute resources, and to hold the system to account.
This 'recalibration' will not happen overnight, he says, but it will happen, fundamentally changing the roles of the DoH and the NHS as 'bedfellows' and freeing the NHS locally from the state enterprise mentality under which it was established.
He is extremely disappointed that the government hasn't yet been able to publish its response to the Kennedy report into the paediatric cardiac services in Bristol, because the necessary parliamentary time has had to be allocated to the cloning bill.
He views the report as a vital one in NHS history, 'bluntly argued and with a scathing analysis of the structural faultlines', but one that has also highlighted how far the NHS has come in a short time.
He will have to wait until the new year before he gets his opportunity to reveal what the future holds for the Commission for Health Improvement, the National Institute for Clinical Excellence, and other structures which have become so vital to the modernisation agenda but did not exist until a couple of years ago.
Speaking of Bristol, he is reminded of the 'fantastic' chief executive United Bristol Hospitals trust now has in Hugh Ross, despite its no-star rating: 'It is had huge problems but it has an absolutely remarkable chief exec - and after everything It is been through, it now has these fantastic heart services.' In fact, Mr Milburn suggests, Bristol illustrates the importance of having high-quality managers, and enough of them.
Work is under way to ensure that primary care trusts have enough management capacity with good people and the right people. And he also reveals that work is under way to establish a proper supported management career structure throughout the NHS, 'to grow good managers'.
But ultimately, providing the best-quality healthcare comes down to money - and now at last acceptance by a government that the NHS has been absolutely starved of cash and will need absolutely loads more of it if it is to survive.
For Mr Milburn, the most exciting thing he finds now is that the debate has changed.
Historically, the health debate has always been about whether the NHS has enough money.Now that everyone agrees there simply is not, It is time to move that debate to the next level: how to find the cash to bridge that gap in order to improve services.
There were two things he claims he wanted to do as health secretary - one was to secure more money for health, and the other was to institute reform.
He believes he has achieved both in the space of three years and says he is not ready to let go of the reins yet. Nor is he at all fazed, he says, by the fact that his boss has health at the top of his priority list domestically, and had just asked him how things were shaping up with the primary care development boards.
'It is a great job, It is a very difficult job as everybody has found who's done it, but It is immensely rewarding, 'he says, before returning to his argument that the people working in the NHS should be telling the good news about the job they are doing.
He is heartened by the enthusiasm he detects across the NHS, what he hears from people every day about what they are doing.
But that message needs to be heard by Daily Mail readers as well, he says.
'do not assume the NHS is going to have the confidence of each generation.We have to go out and gain the confidence of each generation, ' he adds.
He loves an argument, he says, and he is determined to win the one about the future of the NHS:
'We need to have the intellectual confidence to go out and win it for the NHS.We have to take the fight to those who say we can't deliver, that the NHS must be abandoned.
I think the opponents of the NHS have had it too easy.'
And urging the development of 'a big coalition' to protect the future of the NHS, he rather wearily climbs off his soapbox and goes off to his next meeting.
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