A Picture of Health

39 Victoria Street 

“Secretary of State, I cannot fully express our pleasure in welcoming you.” 

“It’s good to meet you too, Humphrey.” 

“Your predecessor proved a little difficult to dislodge but we managed it eventually.” 

“So I understand, Humphrey.  I hope you won’t have to resort to such measures in my case.” 

“No, certainly not.  Mrs Johnson has assured us you are a thoroughly good egg, if you will permit such a vulgar expression.” 

“It’s probably best if we start by taking you through the in-tray.  It looks a little full.” 

“It certainly is, Minister.  I probably should not say this but your predecessor was exceedingly fond of press releases and rather less concerned with reality.  We did wonder if he fell on his head while he was training to be a jockey at Newmarket.” 

“Yes, I noticed that too.  Only last week, you banned the advertising of certain foods on TV even though the scientists told you it would only make a microscopic difference, if any, to childhood obesity.” 

“Yes, I know, Minister, but we had to be seen to be doing something.” 

“Am I right that the biggest outstanding item is adult social care and that you have had a ready-to-go plan for that for two years?” 

“You are correct indeed.” 

“May I see the plan?” 

“Ah well, I am not sure that would be wise.  The PM and the Chancellor have taken it over and we do not know how it now looks. Furthermore, because the plan has to be robust enough to survive future changes in government, the PM wants to discuss it with Her Majesty’s Opposition.” 

“I think you are telling me the Chancellor says we cannot afford it.” 

“You may have put your finger on the nub. Minister.” 

“That’s ridiculous.  We’ve been throwing money at everything else, £39 billion on an entirely useless Test and Trace system, for example. And the Scots have introduced their caring for the elderly solution to applause all round.  Why don’t we in England just copy theirs?” 

“We could not afford it.” 

“If the Scots can, why can’t we?” 

“That’s because the English pay for what the Scots want. The Scots have 30% more per capita resources than the English to spend on public services because we give them the extra money.”

“Yes, I know about all that.  Don’t forget I was Chancellor until Dominic Cummings decided I wasn’t. Joel Barnett, Finance Secretary and also a qualified accountant, devised the formula back in 1978. We’ve had no qualified accountants in the Cabinet since, so no one has been able to work out how to change it.” 

“Very interesting, Minister, but it is funded by Robert Jenrick at the Ministry of Housing and neither of you can do anything about it either.  You might be able to do something about the NHS, though.” 

“Don’t tell me that is beyond help too.” 

“Far from it.  It is the best nourished part of the state: the NHS percent of GDP has shot up since 2000 and that is before the pandemic. However, you are not responsible for NHS England either because it is a non-departmental public body.”

“So I’m the Secretary of State for Health and Social Care but I’m responsible for neither health nor social care.” 

“Yes.  I regret to say that is correct. There is, however, one thing I might suggest: you might persuade Sir Simon Stevens to rescind his resignation.  It may be too late but now that Hapless, I mean Mr Hancock, has gone, he may change his mind. Lady Harding has been lobbying for the job and that is scaring everyone.  Mr Hancock is her greatest admirer, maybe because they both trained as jockeys.” 

“I agree that Simon is excellent and we will miss him.  So, that apart, there’s not much I can do?  My predecessor was always going on about working night and day.” 

“That may be because we have one of the greatest numbers, 29, of arm’s length bodies of any government department and yet Mr Hancock added two to their number. Three of the 29 do come under your authority; they mostly deal with public health.  We need to talk about that later. 11 are non-departmental public bodies which are not really accountable to anyone although Mr Hancock thought they answered to him – except when he needed someone to blame, of course.” 

“Humphrey, you are being unkind.  Matt would never have stooped so low.” 

“If you say so, Minister.  To continue - seven are advisory.  They do no harm as nobody bothers about what they have to say. Then there are eight others which we cannot categorise. One of those is the Morecambe Bay Investigation which finished its work four years ago but we have not had a chance to close it down. Another is NHS Improvement which we also need to discuss later.” 

“Everyone knows the pandemic showed Public Health England to be absolutely useless.  We cheered when, last August, Matt announced he was closing it down.  Then it transpired it would transmogrify into the National Institute for Health Protection, Office for Health Promotion and Health Security Agency.  Now that Chris Whitty, who has charge of the first two, and Jenny Harries, in charge of the third, are TV stars, Matt had to give them some public presence, I suppose, but might it be that you’ve replaced one disaster by three?”  

“Minister, Chris Whitty got to the heart of it when he said ‘Preventing ill health and supporting our communities to live healthy lives is very important.’ Nobel prize stuff that. Meanwhile, Dr Harries explained ‘her ambition to boost public recognition for the vast amount of work that goes into protecting people’s health.’”

“Did I hear that right, Humphrey? She doesn’t want to improve our health, just get us to think they are working hard? All this reminds me of when George Osborne became Chancellor of the Exchequer and announced that the Financial Services Authority was useless (correct) and would therefore be closed.  He then panicked and replaced it with the Financial Conduct Authority (equally useless) and the Prudential Regulatory Board which returned the Bank of England to doing what it did in the first place.” 

“You have to give the civil service marks for consistency, Minister.” 

“You were going to tell me about NHS Improvement?” 

“NHS Improvement is another non-departmental public body, responsible for NHS England's independent trusts and the providers of NHS-funded care.” 

“Humphrey, you are pulling my leg. If the NHS can’t do that because trusts and providers are independent, how can NHS Improvement do it?  And why do we need it anyway?” 

“Well, NHS Improvement is now both part of NHS England and not part of it.  They each have a Board.  Lord Prior and Lady Harding, who else, chair NHS England and NHS Improvement respectively. And Amanda Pritchard, the deputy CEO of NHS England is CEO of NHS Improvement.” 

“No wonder Simon Stevens is pushing off.  This is a madhouse. I will just announce I am concentrating on ending the pandemic.  No one can argue with that.  One last thing, Humphrey.  Please tell everyone to stop using my private email address.” 

“Certainly, Minister. Good luck!”