Health Secretary? No thanks!

It has got to be one of the bum jobs of the Cabinet. Just imagine going into meet with the new Prime Minister, fully expecting to get a post in the Cabinet that will push you further forward in your career, and being told that you are going to become the media's whipping boy (along with the Home Secretary) as Health Secretary. You may as well resign your seat in Parliament there and then, as your career certainly isn't going to go anywhere.

I mean, who would want a job like that? Perched like a demented Gordon Brittas* on top of a vast, dysfunctional (hell, even psychotic) bureaucracy desperately trying to fight fires and deflect body blows from the baying hordes of headline hungry journalists until your inevitable demotion/sacking/return to the backbenches. Who would want a job like that?

Well, I would for a start. It could be one of the great reforming briefs of the Cabinet. You could really make a difference - if you are willing to take a risk and challenge some of the fundamental assumptions about the health in the UK. I'd have a look at convincing the British people of four fundamental truths - and then, once the attitudes towards health have changed, we could have a look at real reform of Health in the UK.

1. The job of Health Secretary is Health, not the NHS

Every Health Secretary seems to focus solely on the NHS. But their brief is broader - they should be looking after, and finding ways to improve, the health of the nation as a whole. Not finding more money to throw into the NHS black hole, and not desperately trying to tinker with a system that is fundamentally screwed. Health Secretaries get a form of political myopia - they cannot see beyond the NHS, and therefore fail to look at radical policies that could make a real difference. Which needs me nicely onto my second point.

2. The NHS does not have to exist

Really, it doesn't. There was once a time when the NHS didn't exist, before Attlee et al created it. It is a human construct, and like anything created by humans, it can be demolished as well. We need to get beyond this limiting political assumption that insists that we must have the NHS. We need to go back to bases and challenge exactly why we have the NHS. Because, quite frankly, it isn't working. It is a leech on government funds, sucking billions of pounds without really offering anything in return. Furthermore...

3. The NHS just can't work

Really, it can't. It was conceived many moons ago, when medical technology was (by comparison to today) in the Stone Age. It was created to service a smaller population, and a population with a lower life expectancy. It is a completely different health service to the one that Attlee created, and with more people and more expensive treatments - it is no wonder that the government cannot afford to pay for it. The massive cost of the NHS was even acknowledged by the NHS creators - after all, it was Labour under Attlee who first started charging for prescriptions. Even the most preliminary examination of the NHS must show that it is, not to put too finer point on it, utterly fucked. And why on earth would we continue to fund something that doesn't work? Because it is a British institution, and it represents free healthcare for all. Except for the fact that...

4. The NHS is not free

Really, it isn't. Yes, it is free at the point of service, but we fund the NHS entirely. The billions thrown at it come from the nation's tax burden. Your income tax and your national insurance contributions fund this creaking, failing tax vampire. The only reason why people think it is free is beacuse when they arrive art A+E, they don't have to pay for it. Solely because they have already paid for it. Seriously. Nothing is free, the NHS just appears to be free when you arrive at hospital. And what is the point of having something that is free at the point of service if, fundamentally, the service is shit because the institution isn't working? This is not dissing those who work in the NHS, but rather acknowledging that they are restricted by the outdated, outmoded and failing bureaucracy they are working for.

I don't know what could replace the NHS, but I rather favour removing all funding for hospitals and instead using the money to fund vouchers for the population as a whole. Let people vote with their feet. The decent, working hospitals will still get government funding through people spending their vouchers in them. Those that are working will not get the funding, and may well end up closing. But, really, so what? If something isn't working, then why continue to fund it? If demand disappears for a supermarket brand, for example, then it goes out of business. Why not the same for a crap hospital? But as I say, I don't know whether this would work. But as Health Secretary I would be looking to change the way people perceive health in the UK - and would judge my success or failure based on whether people still feel the NHS has to exist or whether they are prepared to accept the NHS is past the sell by date and needs to be fundamentally reformed - if not replaced.

So, come on, then, let's not have the job of Health Secretary as career suicide for any incumbent. Let's have a great reforming Health Secretary. Someone prepared to change the perceptions towards the NHS in the UK, and therefore able to contemplate other ways of managing the health of the country.

*If they ever make a TV biography of Patsy, I really do think she should be played by Chris Barrie. Aside from a vague physical resemblance, only Barrie could convincingly portray that air of panicked incompetence that pervaded the senior eschelons of the Department of Health under Hewitt.