I did not hear Desert Island Discs on Sunday, but the guest was Nicola Horlick who was apparently asked if she would like to get involved with the NHS in a professional capacity.
She was, I think, merely responding to Kirsty Young’s question, not announcing some long-held ambition – knowing Horlick (which I did, a little, when she was at Oxford) if she had that ambition she would be in charge of the NHS by now.
Like the many others whose experience of the NHS was positive (in her case the care her first-born had before her death from leukaemia) she is full of praise for it, both for the attention her daughter received and because it is always there, whoever you are when disaster strikes. You think differently, of course, if you lie in an unwashed ward, get MRSA, queue in a waiting list rigged to meet a target, or are left to go blind because your PCT will not give you the cost-effective drugs needed to defer the advance of Macular Degeneration.
It is interesting to speculate, however, what Horlick could do if she did get her hands on the NHS. Within a month, the unions would have signed up to a new agreement putting patients’ rights above those of employees. Matron would return with her rod of iron. Wards would be scrubbed, hands would be washed, and uniforms worn only on the premises.
Within three months, the procurement services would be reformed, resources like operating theatres would be fully utilised and waiting lists would have vanished along with 40% of the administrative staff. Nothing major, just routine stuff in any properly-run business.
But perhaps even Nicola Horlick could not turn this ship round. I saw one of the television programmes in which Gerry Robinson tried to suggest minor administrative changes at a hospital – simple things like using an operating theatre to full capacity and managing the waiting list at a childrens’ clinic. No-one argued with what he suggested, everyone agreed that the ideas were sound, but you could see they were never going to happen – “a thousand reasons to say no” he said of one administrator as his ideas ran into entrenched interests, old habits and ancient animosities between different parts of the system. Then we met the Chief Executive, a man patently devoid of any initiative or leadership skill, and all became clear. The NHS is full of people like this and together they make up “the system”.
Still, it would be good to set Horlick in amongst them and give her absolute power to do what was right. Let’s give her the whole Health brief while we are at it.
Having started down this line, who else might we bring in to Government in place of the pigmy career politicians? Digby Jones should head the whole of the Trade and Industry brief instead of just a part. Alan Bennett would restore real meaning to the word “culture”. Put Alain de Botton in charge of housing, Roger Scruton at Education and David Mellor at Sport. I rather like the idea of Rod Liddle at the Home Office and Simon Jenkins at Local Government. Jeremy Clarkson could head Transport provided that he spent £4 on public transport for every £1 on roads.
One or two real politicians could stay. If you weaned Alastair Darling off the Ketamine he would make a solid Chancellor, especially if given the brief of reducing both taxation and the tax regulations. William Hague would make a good Foreign Secretary. Jack Straw could keep the Ministry of Justice. Bring back Michael Portillo to Defence. Frank Field could return to think the unthinkable at Pensions. Boris Johnson could lead at Health & Safety.
Who is to be Prime Minister? With this array of talent in government, the PM needs to be someone able to curb excessive enthusiasm and apply a quizzical eye to the wilder element. It has to be Jeremy Paxman.
The new government would have as a fixed rule that no new legislation is to be put forward without an accompanying list of nine other enactments which are to be repealed, of which five must date from Blair’s time in office. Each department would be made to reduce its headcount by 5% per year.
All those bright but impractical young ministers – Ed Balls, Yvette Cooper, the Millibands – would be banned from politics for a decade and told they could then reapply with evidence that they had done something useful in the real world which fits them for office. The ghastly Caroline Flint could go back to pulling pints, the only useful occupation she has ever had, preferably in a very smoky pub.
All this fantasy perhaps undermines the original point here. It cannot be impossible to cure the NHS. It was rotten before New Labour started tampering with it to elevate the apparent statistics above the reality and to transfer real power to the pen-pushers and the PFI investors. Nicola Horlick could transform it.