Civil Service: Politicisation

Baroness Murphy Excerpts

Thursday 28th November 2024 Lords Chamber

[Baroness Murphy (CB)]

My Lords, I add my voice to thank my noble friend Lord Butler for introducing this debate. I hovered on the edge of one arm of the Civil Service, in the shape of the Department of Health, and have observed since 1997 the total politicisation of that department with some astonishment and some despair. There is, in fact, no longer a Department of Health and Social Care; there is only a department of National Health Service management.

My first brush with the department was in the early 1990s, when I became the Chief Medical Officer’s personal adviser on mental health and ageing. I was given a somewhat daunting list of 14 telephone numbers. I remember counting them and thinking, “Oh wow—all these experts!”, but the phone numbers were those of civil servants in the department, or else in what was the Home Office and is now the Ministry of Justice, or in the Department of Education and in what is now the Department for Work and Pensions. They were all policy specialists on mental health or ageing. Most had worked in their department for five, 10 or 15 years. Many were frighteningly bright, and all carried in their heads the history of policy positives and negatives. I found them inspiring.

Along came the 1997 election, and Tony Blair swept in with reforming zeal. As an NHS manager by then, I was delighted. I thought, “This is what we want: a bit of delivery of policy”. Shortly after the election, I was having lunch in a Norfolk pub with the much-missed Baroness Hollis of Heigham. Patricia had just been appointed in the new Government as a Front-Bench spokesman on social security. She said, “We’re going to get rid of all those Tory civil servants and get a new lot in who haven’t been contaminated”. I was somewhat surprised but thought that she could not possibly mean the upper middle grades of the Department of Health, and I am sure she did not. But over the next five years, all bar one of my contacts had taken early retirement, voluntary redundancy or moved out to NGOs or other careers.

What has happened since then? There is a department obsessed with the English National Health Service and interested in acute hospital performance and not much else. Mental health and learning disability policy in effect stopped. We have got a new Mental Health Bill in 2024 that is in fact the same as the 1983 Act. Learning disability hospitals were meant to close, but that stopped. Public health policy was eventually all but destroyed by sending it out to local authorities—which was the right thing to do, but they had to find their feet all over again. When the pandemic came along, there was nobody at the centre insisting on responding in the time-honoured way. Track and trace was a farce. Links with the justice system never progressed, children’s mental health was largely ignored, maternity services fell off anyone’s agenda and went downhill, and social care is still being ignored. There has been minimal focus on the antecedents of ill health. Alcohol policy, obesity, lack of exercise and deterioration in family cohesion have all generated nothing except passing interest and a few reports.

Having refocused, did it work to have NHS performance taking over the whole of the DH? Perhaps I shall ask my colleagues around the House whether they think that the NHS has got better. Every three years, we have a new Minister, a new policy, some old policies are recreated, and everything is changed yet again. It has not been a happy story. I think it was happier when we left policy to the Department of Health to get on with what it could do, and we should let managers in the health service—out of the Civil Service—be separated into something quite independent. That is my experience of the politicisation of the health service, and I do not like it.