Feature

Ministers matter to the NHS

Charles Webster wonders whether Frank Dobson will prove to be one of the better health ministers

One recurring lesson of history is that ministers do matter. The choice of new minister for the health portfolio is revealing and of fundamental importance — and it must be accepted that Labour’s record does not entirely inspire confidence.

The one undisputed and obvious success was Attlee’s choice of Aneurin Bevan as minister of health. Bevan still ranks as the outstanding holder of the health portfolio since this post was created in 1919. None of his successors have approached his abilities for constructive reform, or in gaining the confidence of the public, his department and the NHS workforce.

On account of Bevan’s inspiring leadership, the NHS became the best-known and most-admired system of health care in the western world. This set a unenviable standard against which all of Bevan’s successors must be measured.

Regarding Bevan’s Labour successors I would argue, against the tide of conventional wisdom, that Kenneth Robinson (Minister of Health 1964-1968) was a failure, while in my view Richard Crossman’s short tenure as the first Secretary of State for Social Services was a brave attempt to inspire something of the spirit of Bevan into the health department.

But the strongest ministerial team in the whole history of the health department was probably the ostensibly incongruous Barbara Castle-David Owen partnership. Although this ran for only the very short period between 1974 and 1976, during this time there was a sustained momentum towards impressively constructive and enlightened activity across a broad front.

The devastating impact of a change for the worse is indicated by the departure of Aneurin Bevan. The response of the health department to this loss is graphically illustrated by the private papers of Dame Enid Russell Smith, originally not a supporter of Labour, but like most her colleagues completely converted to Bevan’s point of view. On 19 January 1951, on the eve of his departure, Bevan spoke to 200 senior members of the department, an occasion which left the department more unhappy and depressed than Dame Enid ever remembered.

She recorded that ‘no one could be more beloved by his staff’. Even the Permanent Secretary was ‘obviously terribly cut up’ by Bevan’s departure. The officials had good reason for their pessimism. Bevan had defended the interests of the health service with zeal and effectiveness, but his success had provoked jealousy and alienation among his colleagues. Bevan’s removal was used as the occasion to break up his department to produce a ministry ‘normally reserved for second rate ministers’.

On 22 January the officials met Bevan’s successor, Hilary Marquand, who struck Dame Enid as ‘the type of person one might expect to find selling bird seed in a corn merchant’s shop’. Marquand lived up to this initial impression. Very quickly officials realised that he was unsuccessfully struggling to ‘save some at least of his Health Service at which his colleagues are picking like vultures round a corpse’.

Marquand’s tenure extended for only a few months, and was ended by the defeat of Labour in the October 1951 general election, but the damage done to the health service during the first months of that year took more than a decade to reverse.

It is evident then that ministerial appointments are highly significant events and they constitute sensitive political indicators. It is a misfortune that Prime Ministers are prone to select second-rate figures for the health assignment. Only history will judge whether Frank Dobson is like Bevan or like Marquand.

The newspapers are puzzled by Dobson’s appointment. Like Labour between 1970 and 1974, the health shadow duties have passed through many hands, none of them inspiring great confidence, but the most recent, Chris Smith, being regarded with some enthusiasm.

A Guardian leader understandably suggested that Smith’s relegation to heritage and Dobson’s surprise appointment to health was a mistake. Given the many competing claims on the public purse, it would be understandable if some spending departments were neutralised and rendered unthreatening to Treasury discipline.

But given the Prime Minister’s repeated pledges concerning his high level of commitment to the health service, which was undoubtedly a source of substantial electoral benefit, it would be an act of cold cynicism if he has calculated that the health portfolio has been consigned to a minister more fitted to arts of purveying birdseed.