NHS Reform - I don't think so

While leafing through the Sunday Times last weekend I came across some job ads for senior monitoring and other positions connected with the NHS. In the light of the coalition's aim to "reform" the NHS, I couldn't help noticing what is required of those to be appointed.

In addition to the usual diversity bollocks, candidates must have "significant board level experience in a complex, high-profile organisation and the stature to be effective in the Whitehall environment" or "a public or health sector background, with some knowledge of personnel and pay issues and an appreciation of the policy and financial constraints on pay decisions affecting the public sector". They should be committed "to the NHS and its values with the ability to apply their skills and experience to the advancement of the Trust’s business and strategic goals".

The message of the ads is clear. The NHS, despite a cursory nod in the direction of the parlous financial state of the country, wants more of the same: only apply if you have a bureaucratic mindset (honed in large private or, preferably, public sector entities), won't rock the boat and will commit to business as usual. I don't think "reform" quite catches the flavour of such appointments: perhaps "stasis" is more accurate.

This behaviour is not restricted to the NHS. Every similar position in every part of the public sector draws from the same well of smug, already generously-rewarded, uninspiring apparatchiks who have risen without trace in a multitude of non-jobs in dysfunctional organisations. As living examples, each time a scandal erupts in a public sector organisation you will find a senior sinecure holder blinking in front of the TV cameras telling the mugs – again - that "lessons have been learned".

To a lesser extent Big Corp is also a victim of this plague. The same slimy reservoir was apparently dragged to land the non-executive (and many executive) members of the boards of RBS, Northern Rock and Lloyds before these outfits disappeared into the taxpayers' arms. It is no surprise that the FSA – another pit of expensive non-talent – asserted that there were no corporate governance issues involved in the debacle at RBS. Even so, the private sector, generally speaking, has to deliver something consumers want at a reasonable cost and, more to the point, can go elsewhere to obtain. Accordingly, in theory anyway, a minimum of efficiency and executive competence must be achieved or the enterprise will go bust. Nevertheless, the business wing of the political class protects its own. Thus, for instance, in memory of his distant glory days at ASDA, Andy Hornby - despite bankrupting HBOS at minimal financial or, incredibly, reputational cost to himself - was appointed to run Boots.

What Lansley and others in the coalition should do is take a day off and read Antony Jay's Management and Machiavelli. One of the major lessons taught by Machiavelli and highlighted by Jay is that, if you want to reform anything, don't ask those with a stake in the existing set-up to manage the changes required . Needless to say no-one in the coalition would be interested. They'll blunder on and the apparatchiks currently on the payroll – together with those to be appointed per the ads in the Sunday papers - will hold on until Labour returns to re-reform the NHS and, while it's about it, shower them with a new splurge of other people's hard-earned money.

Umbongo