Short abstract
England's secretary of state for health, John Reid, explains why his tactics have been to retreat on the consultant contract but stand his ground on foundation hospitals
It came as a huge surprise to everyone—not least, John Reid himself—when he was appointed health secretary after Alan Milburn's unexpected resignation in June. According to the Mail on Sunday, the reaction of the former Northern Ireland secretary was: “Oh fuck, it's health.”
Figure 1.
Credit: KEVIN FEBRUARY
He laughs, leans back in the squashy sofa in his Whitehall office, overlooking the Cenotaph war memorial, and refuses to confirm or deny the story.
“What is true,” he says, in his soft, unhurried Glaswegian accent, “is I didn't expect to get health. I had not lobbied all my life to get it. I was surprised... but within 48 to 72 hours I had already begun to get hugely excited about it.”
Reid has no record in health. He lists his interests as foreign affairs, defence, and economic affairs. But he does have a good track record for filling the breach when other ministers resign. He took over from Donald Dewar as secretary of state for Scotland in 1999 and from Peter Mandelson as secretary of state for Northern Ireland in 2001, and he became leader of the House of Commons in April 2003 when Robin Cook resigned over the war with Iraq.
Some wonder whether he might even be asked to step in should Geoff Hoon, secretary of state for defence, be forced to resign after the David Kelly inquiry.
Reid certainly sees the idea of the NHS as a battle that needs to be won in time for the next election. He picked up the military theme in his recent speech at the Labour party conference, referring to the NHS as an “army for good” and to waging an “unremitting campaign against illness and pain.”
Yet Reid, aged 56, is hardly a warmonger. He comes across as a man comfortable with where he is in life and jokes about being famous enough now, like Gordon Brown and Mo Mowlam, to drop the “Dr” title (he has a PhD in economic history). He lacks the bumptiousness of some of his predecessors, and his easy self assurance is reminiscent of that of former Conservative health secretary, Kenneth Clarke.
That's where the similarity ends, though. Apart from anything else, Reid gave up alcohol nine years ago and cigarettes in January. It's hard to imagine Clarke doing either.
“I'd like to say it's down to strong will, except I don't know if I'll take another fag tomorrow,” Reid jokes. “It's not unenjoyable, smoking. It's seductive.”
He says that stopping smoking has more to do with marrying his second wife last year (his first wife died from a heart attack in 1998) than any inkling he might get the health job.
Having earned the reputation as a bruiser, he's amused at the suggestion that the health job might reveal his touchy-feely side.
“Whoever does the Northern Ireland job has to have a lot of endurance but at the same time has to try and see other people's point of view. In the case of the National Health Service it is much the same.”
Whereas Alan Milburn backed himself into a corner over the consultant contract, Reid has tried to see the consultants' view, backing down on five of the six points.
“It was sensible to do it,” says Reid. “If I was seen to be reasonable, then a rejection of what we had renegotiated would appear to be very unreasonable. I hope the consultants don't put themselves in a position where they reject this—because I just don't think it will be understood by the public.”
Backing down can be a clever negotiating tactic. But what if it fails?
“We'll cross that bridge when we come to it.”
Reid, a former armed forces minister (he led the controversial reconfiguration of the British army), history lover, and no doubt a military strategist at heart, tends to use military analogies with ease. When we talk about what might make the NHS work, he refers to the Prussian military philosopher Karl von Clausewitz, who argued that armies don't just need physical resources and a military plan, but good morale.
“It's about leadership; it's about understanding and agreeing the objectives, a degree of trust—that whole morale thing is important in any major campaign.”
Foundation hospitals are Reid's battlefield. Despite losing the vote at the party conference, Reid is not planning a retreat. He sees them as essential to patient choice.
“It's no good giving people power to exhibit their preferences if you don't allow the providers to exercise their judgment in responding to local people. You have to decentralise.”
He wants to stop “micro-managing everything from the centre.” Instead he wants to give maximum flexibility to those managing services locally and to give patients the power.
“Giving patients the power to choose is the driving force for all that, rather than me sitting in the centre and dictating to people.”
He is dismissive of the argument that it will mean a two tier service: “The idea that for the last 60 years we haven't had hospitals that are better than others is a joke. It's our intention, within about four years, to make sure that we have raised all hospitals to the standard which would allow them to become foundation hospitals.”
Of course every incoming health secretary wants to make their mark. Patient choice is his. But if Geoff Hoon goes, will Tony Blair be prepared to let Reid stay and see it through? “I don't think Geoff will retire, but even if he does, I think my future lies with the National Health Service for the forseeable future. I genuinely want it to be that way.”