I originally thought I might have been imagining this, but there has been a very noticeable shift in the way much of the Cabinet talk about the institutions they run. The most marked has been in how Jeremy Hunt talks about the NHS: obviously there are current discussions around the Francis Report, but right from the beginning of his tenure as Secretary of State, he stopped talking the NHS being for about doctors, nurses and the mechanics of the NHS and instead talked about patients. He has been – very smartly – positioning the Department of Health as the patients’ champion.
This, as I say, is a very big change in language, of course, but more important is whether that translates – as it should, because how you think about something changes how you deal with it – into a change in attitude and performance as well.
Before Christmas I had the most bizarre conversation with a man who was completely convinced that Conservatives wanted to privatise the NHS. Feel free to check my maths, but there has been a Conservative Prime Minister for 39 of the 65 years since the NHS was established, a Labour one for the other 26, and we still have an NHS. More importantly, he was also convinced that the Conservatives wanted to starve the NHS of public funds to the extent that it would collapse, which again is simply untrue – this government has ring-fenced the NHS budget and while there are arguments over the year we should count from, the fundamental point remains that the concept of the NHS – medical care free at the point of use for anyone who needs it – is an extraordinary and valued part of our national life. I have no argument at all with asking institutions to spend money on the things that matter, and reduce spending on administration, and – perhaps most importantly – to spend what they have as well and as effectively as possible, and I do not care who provides the service as long as it is a good one.
One of the most promising themes that the Conservatives offered in 2010 was that of choice and control. I’ve written before about how important it is that users of public services can vote with their feet and use their choice to drive up standards so that our public services offer the best possible outcomes. The only way that this will happen though is if institutions are allowed to respond to local demands. And the only way that that is possible is if ministers stop ring-fencing particular items (I’m back to my bin obsession, but it’s a good example), demanding boxes be ticked for things that they think are important, hand responsibility to the people on the ground and allow public services to actually serve the people who pay for them rather than some centralised bureaucracy which dehumanises us all.
Each government minister should be thinking like Jeremy Hunt in this: how can we ensure that our departments are human in their thinking, serving the people not the machine, and making the best of what they have? Partly for political reasons (so that between now and the election we can say, we’ve made your life better and easier in this way), but mostly because it’s the only way that our institutions, economy and national life will thrive, it’s vital that every minister behaves as well as talks like a people’s champion.