June 21, 2021 - 11:45am
Word that Dido Harding — she of the Test and Trace fiasco — has applied to be the next Chief Executive of NHS England was controversial even before her suggestion yesterday that the Health Service be weaned off its reliance on foreign staff.
It isn’t obvious why this should be a priority. There may be a principled case for not poaching skilled professionals from other countries that also need them, but in raw political terms there is no immigration more popular than Health Service immigration.
Others have criticised the very idea of candidates for such a role effectively ‘campaigning’ and making policy offers. Professor Tim Bale, of Queen Mary University, sums up the sentiment:
“This is a really worrying development. If candidates really are going to campaign publicly for their appointment (something that’s bad enough already), then they should be stressing their competence and their experience, not spouting this sort of crowd-pleasing nativist nonsense.”
- Tim Bale
But beyond the specific merits of the proposal or the candidate, however, any such worry is misplaced. In fact, having the political dimension of senior public sector posts acknowledged is a healthy democratic development.
The Chief Executive of NHS England is responsible for policy decisions which affect millions of patients and medical staff. It is right that politicians, and the public, have an opportunity to get some idea about how they will make them.
Peter Mair, in his excellent Ruling the Void, sets how modern liberalism often tends to restrict the scope of democracy via, among other things, framing debate in terms of qualification.
‘Competence’ and ‘experience’ are not neutral concepts. They imply a shared understanding of the end of any given role, with only the question of means up for debate. This is fair enough for junior roles or positions in the private sector, where goals are usually defined by the specific commercial objectives of the individual or institution doing the hiring.
But a state — at least, a democratic state — doesn’t function that way. Public sector leadership is not just about who is best placed to do an agreed thing in an agreed way. A nation which undergoes regular changes in political leadership must ensure the permanent state tracks such changes.
The Conservatives have historically been bad at this, with the consequence that many public bodies and quangos remain led by New Labour appointees, still working towards Blair-era ideals. That they conceive of their roles as neutral does not make them so.
Where Tory policymaking has been most effective, it has often been partnered with some progress in driving change in this sphere. One thinks of the appointment of Sir Michael Wilshaw to head Ofsted during the heyday of Michael Gove’s school reform programme. Today, with culture and media high on the agenda, Tim Davie has made at least some efforts to drive change at the BBC.
In truth, they could go a lot further. Why not legislate so that the head of every quango must be reappointed (or not) by a new government? The operation of the state, and indeed the quasi-state, is seldom apolitical, and both parties when in office should have the right to ensure it is on the same page as them.
Join the discussion
Join like minded readers that support our journalism by becoming a paid subscriber
To join the discussion in the comments, become a paid subscriber.
Join like minded readers that support our journalism, read unlimited articles and enjoy other subscriber-only benefits.
SubscribeI agree. I don’t understand the opposition to political appointments.
People in this country often seem critical of the US practice of appointing judges based on their political position, as if our judges have no ideological bias what so ever. Without this external check, the judiciary in this country has become a monoculture of Liberal judges, who ensure only other Liberal judges can progress. The same applies across the board in public sector positions, where left wing liberals are the dominate demographic in the sector but are supposed to be serving a right of centre government.
Allowing the heads of these institutions to reflect the position of the democratically elected government of the day, would allow the inherent bias of these organisations to be at least somewhat mitigated.
People should keep politics out of their job. They should – must – be seen to be impartial in their day job. Else you get the BBC. Do we really want this?
Although it is clearly true that, “…in raw political terms there is no immigration more popular than Health Service immigration.” I do wonder why the left support such neo-colonial strip-mining of poorer nations’ healthcare personnel.
Yes it’s strange that, and to the question ‘Well then who is going to nurse/care for the sick/old in country X?’ there is no reply. The western economies are exploiting the resources of other countries. I thought that wasnt appropriate? It was all about saving Employers money. Care workers wages are low and yet care home fees are thousands of pounds a month, and while it’ may be 24/7 care its not 1:1 over that period. As per another piece in Unherd the unlimited immigration played right into the hands of those who wanted to minimise wages and reduce or cut our own training schemes.
We have come to a very sorry state of affairs if we have to embrace politicising the civil service, but perhaps it is the only way out from where we are. But is Dido Harding really the best we can do?
The problem here is not politics but the quality of an appointment. If the candidate has a track record of failure at TalkTalk and Track and Trace, why is she being considered? Hopefully she isn’t and this is just more self promotion by a horsey mate of Matt Hancock!
At these higher levels of decision-making, the appointments will always be political. Working in healthcare, however, I would expect that the person in charge should have a deep professional understanding of how the sector works. Just being Oxbridge educated ‘Masters of the Universe(sic)’ is not qualification enough to run the NHS unless it’s in medicine. When this week the Parliamentary Under-Secretary of State (Minister for Prevention, Public Health and Primary Care) describes dentists as playing an ‘ad hoc’ role in oral cancer detection you immediately know they have very little knowledge of ‘Prevention, Public Health or Primary Care’.
‘
“It isn’t obvious why this should be a priority. There may be a principled case for not poaching skilled professionals from other countries that also need them, but in raw political terms there is no immigration more popular than Health Service immigration.”
But this IS the mission of the NHS. I am a conspiracy loon, and have always believed NHS is a political organization which does health on the side to justify its self. NHS is Deep Swamp, and comes from all the Left drives and its big goal was to enhance Migration, to make it attractive and needed. Under Blair the educating of Medical Personal finally was made so bad the British mostly gave up being nurses and Doctors, and anything under that was strictly for foreigners. (Thatcher did not help by funding it properly, but that was a huge recession time)
Pay and prestige were so lowered (I think intentionally, but maybe because the people loved the NHS, but did not want to actually pay for it) that the best did not want medical school anymore. The lower jobs were made so undesirable that foreigners of low skills were the mainstay. Home Health Care is all foreigners.
For what ever reason the Left wanted massive migration, and the money right did as well. It may be as benign as mitigating the impending British birth Demographic collapse, or it may have been for other reasons, but I always felt the NHS was the mechanism intentionally used to drive this being accepted. I do not believe it is cheaper to hire foreigners to do normal jobs rather than paying what the market demands – that is a false economy, and is what the NHS is all about.
But then I was from London, leaving in the 1970s, and have returned to watch its change since, and it is not the place I left by any means – and no one knows, or says, why this was done.