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Sir John Redwood is MP for Wokingham, and is a former Secretary of State for Wales.

In 1983, Margaret Thatcher and her ministers were worried about the quality of healthcare and the cost of provision.

The Government was completely behind the popular principle of care for all those in need provided free at the point of use. It accepted that it would have  to increase spending year by year as the service grew through more people and as it offered a wider range of treatments. It wanted to check out if the NHS was well run and how it could be improved.

They appointed Roy Griffiths from the retail sector to offer an outsider’s view of how well managed it was. In the one memorable sentence of his report he said

“At no level is the general management role clearly being performed by an identifiable individual. In short, if Florence Nightingale were carrying her lamp through the corridors of the NHS today she would almost certainly be searching for the people in charge.”

He wanted professional managers placed into accountable roles to ensure every pound was well spent and every patient receive a good quality service.

In the years that have followed the NHS has more than made up for any shortage of professional management detected all those years ago. It has also been put through substantial reorganisations by Labour, the Coalition and now the Conservatives.

When I recently asked the Health Department how many chief executives there are of differing health bodies under NHS England I was told the Department did not know. Strange that as they must know enough to be able to include their pay in  budgets and ensure they get the cash.

When I asked what the extra money recently awarded to the NHS to reduce waiting lists was going to be spent on, I was told they were working on a plan. When I asked how many extra nurses and doctors they would recruit to tackle the waiting lists, I was told they were working on a manpower plan. I have never understood why with all the extra money put into the NHS by Labour and now by the Conservatives we never end up with more hospital beds or with sufficient extra capacity.

Listening to ministers, they do not seem to find it easy to get the management information they need. They clearly do not have the information needed to answer quite general queries from MPs and others over where the money goes.

I do not know how Cabinet can sign off on a large extra sum to get the waiting lists down when there is no sign of a detailed spending plan to bring this about. Indeed the senior management of the NHS decline to offer any forecast figure of how much success they will have in cutting waiting lists and boosting output of treatments and procedures for the very large and precise sums of money they demand.

It is as if, 40 years on, Florence Nightingale would now be scurrying along serried corridors of managers trying to find out which one of them could make a decision or was willing to give us any answer.

It appears that what lies behind this is the reorganisation which created an NHS England with its own Chief Executive. This grew out of the ‘agency trend’ in government, where ministers of all recent governments decided that they should stick with high level aims, policy, and allocation of cash whilst allowing more and more of the implementation and detailed work to be carried out by professionally-run, semi-independent bodies.

The attraction for the minister was he or she could say then that individual cases or badly run hospitals were not his or her fault, whilst the attraction for the public was the idea of professional management free of political interference which might create unhelpful pressures.

Instead, these agencies still leave the minister responsible for any mistake they might make. The public and the Opposition rightly expect the minister to come and answer the difficult questions if a hospital kills too many patients through negligence or if there are delays in getting certain types of treatment or supplies where the managers have failed to put in enough capacity. It is too easy for the professionals who control the staff and the information to claim any problem is simply the result of too little money being put in from  the top, whatever the true causes.

The ministers who use the defence that they are not in control of management and cannot achieve things people want from their NHS need to understand the public expect them to fix it, whoever made the mistakes. They have the ultimate power to hire and fire the professional managers, and the power to reorganise the management structure if it is delivering badly.

Sajid Javid has a huge job and a hugely difficult job. I hope he has full confidence in the CEO of NHS England. If he has he needs to work closely with her, mentor her as a good hands-on chairman of a company does, and set her targets and objectives that are stretching but fair. He needs to be the patients’ representative urging great and timely care, and the taxpayers’ saviour, requiring value for money.

If he does not have that sort of relationship, is kept at arms length and lacks the information he needs to know what is good and what is not working, then he needs to insist on such a relationship immediately. If it is not forthcoming then he needs to find a CEO who can work with ministers and deliver a  great service at a realistic price to taxpayers.

Ministers need to include regular  reviews of independent bodies as a crucial part of their task. There should be formal reviews of budgets, of annual performance, and of policy.

The Health Secretary presumably has daily contact with NHS management. Familiarity must not breed complacency or an unwillingness in private to challenge and to hold to account. Highly-paid NHS senior managers should be able to explain what they are doing, how much it costs and how well it is working. They should know how many people they employ and how many extra staff they need.

When there is a highly visible problem like the long delays and ballooning waiting lists they should expect tougher questions and the removal of managers who cannot use money well and solve the problems. I look forward one day to getting some simple and accurate answers to some obvious questions about costs, outcomes, and headcount.