“I try to avoid saying things that are capable of misinterpretation,” Andrew Lansley told HSJ last week.
Readers will judge for themselves whether the health secretary has been successful in achieving that goal during his first year in office.
Politicians are rarely unhappy when talk of “too much bureaucracy” is translated into “too many managers”
As soon as the question was asked, the health secretary adopted his now familiar tone of barely restrained frustration: hadn’t he always attacked “bureaucracy” and not “managers”? Hadn’t he always praised the importance of good “management”?
He was not responsible “for what the Daily Mail writes”.
This is disingenuous rubbish. Mr Lansley - in common with many politicians - is rarely unhappy when talk of “too much bureaucracy” is translated into “too many managers”. Praise for those in management roles is saved for speeches aimed at NHS leadership which are unlikely to get wider coverage elsewhere.
But the language on management resource is changing.
Mr Lansley has begun to use the term “over-administered” as opposed to “over-managed”. This is surely a nod to the seminal King’s Fund report on NHS leadership which made exactly the same distinction.
It also links into a developing theme. Mr Lansley’s office was very keen to stress to HSJ that any criticism of “over-management” applied only to the non-provider sector. The implication is that many of those working in national and commissioning roles are bureaucrats who add little value.
That point of view was challenged directly by NHS Confederation chief executive Mike Farrar, who spoke of both the “dangerously low” levels of management in the service now and the future management cost limit.
Mr Lansley dismissed the idea that this would have any impact on patients.
But HSJ understands that it was not the first time Mr Lansley had heard such a view last week. In a private meeting, Royal College of GPs chair Clare Gerada told the health secretary that patients’ lives were at risk as a result of the way in which the reforms were being implemented.
Mr Farrar called for an end to “crude” targets for management numbers. Mr Lansley speaks of imposing a “discipline” on management costs and reminds the NHS it is getting off lightly when compared with other public services.
So far, so depressing. But discussion at the NHS Confederation conference revealed a rapidly strengthening policy trend - and its clash with Mr Lansley’s plans could make things even worse. Competing with the heath secretary’s desire for “liberation” and “choice”, is a growing determination that the reforms must not be accused of undermining the “national” nature of the NHS or weaken performance in high profile areas such as waiting times. These concerns are lining up alongside the growing importance of keeping a grip on finances as the key drivers in this government’s stewardship of the NHS.
To hold the line on service provision, waiting times and financial performance at a time when primary care trusts and strategic health authorities are being eviscerated will mean only one thing - increased central control. Given that control will be delivered by a “centre” undergoing its own cutbacks, it will often be pretty blunt.
Mr Lansley has declared it is now time to press on with the reforms. By insisting on maintaining the blanket management cost reductions in the non-provider sector he is making another rod for his own back. HSJ predicts that pressure from elsewhere in the government, as well as the growing complexity of the reforms, will see yet another (disguised) U-turn - although, sadly, not before some of the fears expressed by Mr Farrar and Dr Gerada are realised.