Here's what the Civil Service and NHS need - Bernard Ingham

What’s wrong with the Civil Service? And what’s right with the NHS? Debate on both topics is raging because, like Labour still, they are not working.
Dominic Cummings. Pic: Getty.Dominic Cummings. Pic: Getty.
Dominic Cummings. Pic: Getty.

As one who spent 24 years in the Civil Service and has first-hand knowledge of our public health service before the launch of the NHS in 1948, I offer analyses and routes to improvement.

It is no surprise that the Civil Service is not running on oiled wheels.

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In Boris Johnson we have a gambler and risk-taker while the Civil Service is innately cautious. Hence, perhaps, the extent of working from home because of the pandemic to the detriment of services. Tax, probate, road licensing are ready examples. In short, there is a clash of cultures as well as a lot of inexperienced Ministers. And it takes a strong Minister to enforce his or her will on the machine. They need to be continually progress-chasing.

This is not necessarily because the Civil Service is being deliberately obstructive. It moves at a different pace from politicians under political pressure, although I have seen it perform magnificently in crises.

I am not entirely impressed with Dominic Cummings’s argument that it needs more scientists, technologists and weirdos like himself. The PM’s former chief adviser is perhaps his own worst advert. Certainly, its scientific and technological ability needs strengthening but there is not a blind bit of use importing technocrats if they cannot lead, motivate and generally manage the system.

I have known brilliant scientists who were politically dead zones as well as top civil servants who, apart from being ridiculously secretive, had some curious notions as to what would run. In short, as with the NHS, it all comes down to people – their competence, imagination, drive and, above all in the Civil Service, “political feel”. One former Cabinet Secretary once accused me of being “always a politician”, without suggesting I was politically biased. I pleaded guilty on the spot.

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A No 10 press secretary is not much use if he can’t tell Ministers how a policy will be received.

I think it follows that the recruitment template for civil servants needs tweaking towards scientists and technologists who combine management potential with political sensitivity. It could also usefully toughen up its demands on people and carry fewer duds.

Dr Alan Hardy Clegg in old Hebden Bridge will for ever live in my memory as a model one-man band who was always available. He never let my ailing family down, even though I am sure my parents could never meet his bills.

The NHS needs that concept of public service – loyalty to the Hippocratic oath – injecting into its machine, especially with today’s striking doctors doing their profession’s image great harm.

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Their behaviour is curiously at odds with the George Medal awarded to the NHS for the performance of the best of its staff during the pandemic. So is doctors’ opposition to face-to-face consultation. I can understand their reluctance to hold surgeries full off coughing, sneezing patients in a pandemic. But it is another thing to treat them at distance, given the level of immunisation, even if the Omicron variant is at large.

We are now reaping the consequences in an alarming waiting list for treatment and diagnosis that will take years to eradicate. In the meantime, lives that could have been saved will have been lost.

The NHS has been in difficulty for the last 40 years at least with an ageing population and medical innovation. It has also become a bureaucracy under siege from a litigious public who sadly have sometimes been let down. It is impossible to argue that the NHS always has enough money. But the taxpayer will not eventually get value for his brass unless there is root and branch reform of its motivation and a bloated, backside-protecting bureaucracy, plus a drive to secure excellence through proven best practice.

I suspect that it has grown rather like Topsy into what, for all the breakdown into local trusts etc., is effectively unmanageable because of red tape. My instinct tells me it is a struggling asset that needs to be let loose to serve the public in a cost-effective way.

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That, above all, will require inspiring leadership. Where are these paragons of quality service delivery? How do we find them? How do we encourage them to make it their life’s service without chucking unaffordable six-figure salaries at them?

It’s about time the NHS and Civil Service started looking for them as an essential element of reform.