It we consider the role of the UK Secretary of State for Health and Social Care, who as we know is currently Wes Streeting, then it is worth a brief gander at the complexity of what he is supposed to do. How he is supposed to provide political oversight of the NHS?
For example, the vast size of the NHS AfC workforce as detailed in the Thirty-Eighth Report of the NHS Pay Review Body - all 120 pages of it.
Appendix A Data appendix
Workforce
AfC workforce across England, Northern Ireland and Wales...
2. In September 2024, the most recent date for which data is available for all three countries, there were 1.36 million FTE AfC staff in England, Northern Ireland and Wales, of which approximately 1.21 million were working in England, 61,000 in Northern Ireland and 89,000 in Wales. On a headcount basis there were approximately 1.54 million AfC staff as of September 2024, of which approximately 1.37 million were in England, 69,000 in Northern Ireland and 104,000 in Wales. We also track the trends in the workforce and Figure A.1 shows the change in staffing numbers in each year since 2019.
Workforce
AfC workforce across England, Northern Ireland and Wales...
2. In September 2024, the most recent date for which data is available for all three countries, there were 1.36 million FTE AfC staff in England, Northern Ireland and Wales, of which approximately 1.21 million were working in England, 61,000 in Northern Ireland and 89,000 in Wales. On a headcount basis there were approximately 1.54 million AfC staff as of September 2024, of which approximately 1.37 million were in England, 69,000 in Northern Ireland and 104,000 in Wales. We also track the trends in the workforce and Figure A.1 shows the change in staffing numbers in each year since 2019.
There is an executive summary of the whole document, but the question of political oversight remains.
It seems vanishingly unlikely that Wes Streeting has time to oversee the NHS in any meaningful sense while at the same time engaging in the the political machinations of the Cabinet, especially if he has his sights on Keir Starmer's position.
It seems vanishingly unlikely that Wes Streeting has time to oversee the NHS in any meaningful sense while at the same time engaging in the the political machinations of the Cabinet, especially if he has his sights on Keir Starmer's position.
It's a small reminder that describing politicians as actors on the political stage is not an excessive exaggeration. The complexity of government is likely to be overwhelming for most government ministers. Even a cursory examination of what the UK government does tells us that. It is far easier to play politics and probably more rewarding.
7 comments:
It would be really refreshing if Wes didn't have to pretend to know everything about his areas of responsibility, and could just publicly admit that he has a team of civil servants who could provide him with summaries of stuff like the AfC, and that his role is to make intelligent decisions in the light of those summaries.
He won't, of course. He took the job knowing that he had to pretend to know what was going on, so he's judged on the quality of his bluffing. Meanwhile, people need medical treatment which they don't get...
Two Tier delenda est.
The answer to the political conundrum is to shrink, vastly, the role of government. Government is principally for doing collectively what we can't do individually.
It's secondarily for doing collectively what we can't do at all well individually - though I suspect there aren't terribly many things in the category "the govt can do this better than we can." Shrink the state!!
The entire parliamentary Labour Party comprises actors of varying degrees of ability.
If you were being charitable (me?) you could argue that Ministers should be the equivalent of Chairman of the Board. Not involved in day to day running of the business (that's the job of the CEO or even CFO) but setting overall business direction.
If the Ministers are to be criticised it is because they can't help (or are expected to be) getting involved in matters that other board members should be dealing with. It's tricky being a hands-off Chairman and a pity that politicians are expected to do too much small stuff (and not enough big stuff).
Sam - I agree, it would be refreshing. The endless bluffing is tedious and significant numbers of voters seem to have noticed.
dearieme - yes, shrink the state, the gargantuan size of it is the main obstacle to even modest reform.
James - and remarkably limited ability too.
DJ - political parties don't seem to attract people capable of being Chairman of the Board, as if that's not what they are after for winning elections. They seem quite willing to take on charlatans if they demonstrate an ability to persuade and evade.
Searched for what these acronyms meant. Wished I had not. Result.
How do I calculate the FTE / WTE required for a role? (BSA)
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The Full Time Equivalent (FTE) / Whole Time Equivalent (WTE) is calculated by dividing the number of required hours for the role by the whole time equivalent (37.5 hours).
The FTE / WTE entered in Trac must be less than or equal to the FTE / WTE against the position number in the Electronic Staff Record (ESR)
I did not bother searching for AfC. Probably rude.
Doonhamer - AfC, Agenda for Change, sounds like a vast bureaucratic can of worms to me. Conclusion - bureaucrats love acronyms and cans of worms.
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