Ministers are often accused of lack of leadership, of bottling-out of difficult decisions, of passing the buck, or kicking a sensitive item into the long grass, such as revaluation or road charging. But in other areas, they display opposite and no-less-unhelpful tendencies. In this case, they become involved in detail and micro-manage, pouring out regulations and directives which turn into a mire of red tape. Nowhere is this paradox of not making decisions on the one hand, and getting too involved in detail on the other, more evident than in the NHS. Warnings at its foundation that the crash of every bedpan in every NHS ward would reverberate around Whitehall are only too obvious, as Patricia Hewitt would doubtless agree. So, the report this week from the IPPR, New Labour's favourite think-tank, arguing that the decision-making process in the NHS over hospital change is hampered by ministerial involvement, and that local authorities should take more responsibility through scrutiny, comes at a particularly opportune time. The IPPR argues that the current system makes the public suspect decisions over local health services and hospital closures are politically-motivated, because ministers decide. Instead, ministers should be by-passed in favour of councils It is not without coincidence that the report emerges during the current interregnum with Blair in office but not in power, and Brown in power but not in office. This is plainly food for the new prime minister and one he is likely to view with interest. After all, his decision to hand over interest rate-setting powers to the Bank of England in 1997, thereby removing at a stroke the political hot potato of rate rises, was a successful exercise in devolution. It is also just the kind of bold initiative that he will want to repeat on his arrival at Number 10. There have been rumours recently that he wants to cut the NHS loose from ministerial control so that secretaries of state don't find themselves all over the tabloids because of pensioners left on trolleys in a ward in Bishop's Stortford. The IPPR report hands the intellectual case for such a change to him on a plate. Michael Burton Editor, The MJ
