The Week

The Week, 20 May 2022

How can the structures and leadership of our institutions help to maximise the grip and impact of decision makers? It is striking to note just how much of our current discourse involves powerful people explaining that they are powerless to intervene in some of the challenges we face — or making moves to change the structural dynamic.

Number 10 and the Cabinet Office

On Thursday it was announced that a large slice of the Cabinet Office would be split off and brought directly into the structure of No. 10.

There are several reasons for this. Significant reform to the systems immediately surrounding the executive have been on the agenda since Boris Johnson became Prime Minister. Dominic Cummings aspired to a major shake up that would see the establishment of a “NASA-style” command centre, and the influential GovernUp programme advocated for a new Department of the Prime Minister even before Johnson took office. Since then, there has been the sense that the pandemic has revealed an executive core that, dream-like, is incapable of moving at pace in response to an emergency — and, just as significantly, a political imperative to turn the page on a Downing Street operation which has seen staff receive the most COVID fixed penalty notices of any organisation in the country.

The Cabinet Office itself is a strange beast: an early 20th century invention to bolster Cabinet Government with a suite of committees, it effectively absorbed the Civil Service Department (set up by Wilson to strip Civil Service management from the Treasury; abolished by Margaret Thatcher as part of a programme of efficiency and streamlining) in 1981. Since then it has become the broad-portfolio home for almost any given high priority policy area: a hub for coordinating activity and driving delivery as close as possible to the Prime Minister.

But not close enough, it seems. This change will greatly empower the personally appointed Permanent Secretary at No. 10, Samantha Jones. A great deal of the implementation of domestic policy will now answer very directly to the Prime Minister’s office.

While this could help to promote a focus on outcomes and delivery throughout Whitehall, and support coordinated working, it is worth noting that a very responsive ‘nerve centre’ is not the same thing as the direct grip on policy challenges that the Prime Minister may desire — and is no substitute for tackling the deeper pathologies of what is in many ways an outdated and overcentralised Whitehall system. Look out for much more on this subject from Reform in future!

The Treasury and the Bank of England

With the cost of living crisis continuing to make the weather in Westminster this week — and inflation already up to 9% — many people are now arguing that the Bank is failing to act. On Monday, the Governor Andrew Bailey told the Treasury Select Committee that the Bank of England is, for the most part, “helpless” to intervene: the factors contributing to inflation are, after all, global. Meanwhile, at the annual CBI dinner, Chancellor Rishi Sunak also reflected on his lack of power, saying that “there is no measure any government could take, no law we could pass, that can make these global forces disappear overnight".

It is unusual for Government to spontaneously choose to reduce its own power. Yet this is precisely what Gordon Brown did in his earliest days in Government when he announced the independence of the Bank of England. Ever since, the Bank has near-autonomously managed the money supply, set interest rates, and worked to keep within its inflation target — currently 2%. On this latter objective the Bank is, evidently, not doing well.

Policy debate is once again turning to the structures of both the Treasury and the Bank. Should the former — so often thought to be far too powerful a player in Whitehall — be split in two? Was the Bank’s independence actually a bad idea? There are arguments to be made in both cases, but — as with the rearrangement of Downing Street structures — it seems unlikely that structural shifts alone will enable the Government to stabilise the economy.

Example three: the acute bias in the leadership of NHS England

NHS England, whether you call it a ‘non-departmental public body’ or a QUANGO, is an extraordinarily powerful organisation. Its leadership tells a tale about the priorities of our health system.

On Thursday, Chris Hopson was announced as the new Chief Strategy Officer for NHS England. Hopson is currently the Chief Executive of NHS Providers, the membership body for trusts. Hopson’s appointment furthers the dominance of those with experience in the acute sector at the top of the NHS’s executive structure - the Chief Executive, Chief Operating Officer, and Chief Delivery Officer are all former trust Chief Execs.

Despite a rhetorical commitment to moving towards a more primary care and community-oriented NHS, acute players continue to dominate the upper echelons of the organisation.

Some recommended reading this week

Staying with health, there was some interesting writing this week: a report from think tank Policy Exchange on the need to devolve the commissioning of specialised healthcare services; some rare good news on the success of the HPV vaccination in effectively wiping out cervical cancer among women under the age of 28; and a very important piece in the BMJ on the need for a better and more realistic "contract" between an (ageing) population and its doctors. All well worth a read.

Finally, I recommend this interesting article from Claudia Chwalisz on the potential for citizens’ assemblies to reset the relationship between Government and citizen.