Opposite Alan Johnson’s desk is a plaque from the Chinese health ministry — a gift that must, at times, seem like a taunt. The Health Secretary controls 1.3 million staff, more than anyone bar the commander of the Red Army. His £120 billion budget is greater than any government department in Beijing. The Chinese economy and the NHS were both subjected to limited market-based reform — yet there the similarities end. Deng Xiaoping succeeded. Tony Blair was ousted. And now Mr Johnson stands in charge of the largest bureaucracy on the planet.
We have heard strikingly little about health since he took over, which he regards as a success. The Blairite health reform agenda had led to the most bitter feuding in government — at one stage, a Gordon Brown doll was dangling from a noose at one desk in the health department. His predecessor, Patricia Hewitt, latterly needed bodyguards when she went to speak to nurses. Now the ever-smiling Mr Johnson has calmed the department. The reform agenda has not died, he argues — it has just been rephrased.
‘The task we set ourselves was to change the language,’ he says, reclining in his office sofa. ‘You have to find a way of talking that takes people with you. Before it was all managerial-speak — practice-based commissioning, payment by results and all of that. It’s not language that people relate to in the health service.’ Surely it is more than that, I ask: what about those cancelled contracts for the private clinics that had been expected under the Blair years to carry out up to 10 per cent of operations?
His answer is fascinating. Contracts were cancelled, he said, because they were not needed: the very threat of competition unblocked NHS bottlenecks. ‘When you introduce these [private] centres, you find that performance suddenly zooms in the local NHS hospitals that had previously said they couldn’t do any more hip replacements,’ he says. ‘So you had to decide if taxpayers’ money would be well spent on a lovely spanking new [private] centre that very few people would use.’
All this is testimony, one might argue, to the power of competition. So why not have more of it? Stir them up even further? ‘We’re not doing these things for the sake of it, as an ideological challenge,’ he says. ‘We’re only doing what is necessary for the health service. So the capacity issue is still central to this.’ If he thinks the Blairites were being ideological in the pursuit of the internal market, he does not say so in these terms. But it is hard to think he was referring to the Tories.
Instead of accusing Mr Johnson of caving in to the unions (a charge made by a few of the Blairites), Andrew Lansley, his Tory counterpart, is attacking from the other direction. The central Tory proposal is to grant operational independence to the NHS. Mr Lansley says that the NHS has had too many re-organisations, and it would have an independent board under the Tories to ensure it is not so disrupted in the future. This, Mr Johnson says, runs the risk of leaving the health service dangerously unaccountable.
‘The NHS, love it and bless it, concentrates on issues that it sees as priorities,’ he says ‘For example, a clinical discussion can go on in hospitals saying mixed sex accommodation is not so important. But the public feel it is important.’ Last month, he gave the NHS 14 months to have men and women in different wards — an order which he says a Tory health secretary would be unable to make. ‘It is hot breath down their necks that makes things change,’ he says.
While the Conservatives have supported the government on welfare reform, there has been no support on the remaining health reform. ‘We asked GPs to open in the evenings and on Saturdays. The Tories opposed it, using the same argument as the GPs — that accountants don’t open on a Saturday morning so why should GPs? They actually helped write the doctors’ petition. They went marching with them. As the Health Service Journal said, it’s easy to oppose closures; it takes a real perverse genius to oppose openings.’
Yet David Cameron’s strategy is to make the public consider there is no risk to the NHS from Tory cuts: hasn’t he proved himself a worthy opponent? This Mr Johnson will grant — in part. ‘Initially, Cameron had people looking at him and thinking: he’s likeable, fresh and different from the other Tory leaders. He took his copy book from Anthony Charles Lynton Blair. In the early stages that worked.’ But that was then — now, Mr Johnson argues, this charming man is beginning to irritate the public.
‘Now, he’s not so fresh and he’s not so new. And, actually, not so likeable. He’s got to watch this Flashman tendency coming back in.’ You read this correctly: Harry Flashman, the womanising, cowardly bully from the George Macdonald Fraser novels. ‘There is something of the Flashman about the way he acts at the dispatch box, particularly with the Prime Minister,’ Mr Johnson proceeds to explain. ‘You might call it the Bullingdon Club. There is a bit of arrogance there, and that is not very likeable.’
If he is right, the opinion polls show little sign that the public agree with this assessment. I ask if Mr Johnson sees in the British jobs for British workers imbroglio the signs of Labour’s core vote deserting the party. ‘Among core voters, we have kind of reconnected — in the sense of being concerned about child benefit, making sure pensioners are looked after,’ he says. ‘I think our issue is: how do we reconnect with the seats that we won that are not our core vote, how do we keep together the great coalition that Blair won in ’97 and won again in 2001 and 2005?’
That will be even harder in the recession now underway. But this time, he says, it will be different, as the back-to-work infrastructure is far greater. ‘What happened in the Eighties and what happened to a certain extent in the Nineties is that whole areas, Hull for instance, were just left with no help at all. If we can get through this, a year, 18 months, even two years, with all the agencies focusing on how you give people skills to fill the vacancies, then you will have a completely different picture at the end of this than you did at the end of the Eighties.’
Two years? This sounds rather more pessimistic that the official Treasury forecast for a recovery starting in July. I ask if I heard him correctly, and he reddens. ‘This will last for as long as the Treasury is saying it’s going to last,’ he says. ‘Look, it is very difficult to win a fourth term. Particularly in such circumstances. But the other iron rule of politics is that, in difficult times, people cling to nurse for fear of something worse.’
This article first appeared in the print edition of The Spectator magazine, dated February 14, 2009