Colin Talbot on Health Policy

Professor Colin Talbot comments on a recent Leaders We Deserve post discussing political leadership and health policy.

Colin is Editor-in-Chief of the International Journal of Public Administration, and blogs through his whitehallwatch site.

He responded to the recent post in LWD which discussed a meeting called by Prime Minster Cameron. The meeting appeared to be an attempt by David Cameron to retrieve the reforms planned for the NHS. In the post I noted:

A major policy initiative always risks initial resistance at least part because of the difficulty in communicating more than a few broad elements to a wide set of audiences with different concerns. As we have seen, the dilemma is how to accept that plans have to be modified without appearing to ‘flip-flop’ (an accusation aimed at politicians who are seen as changing their intentions). Dilemmas crop up when leaders face hard to resolve decisions. Creativity is often called for to avoid the most obvious and unpalatable actions. David Cameron may not have found enough creativity to go with his undoubted conviction politics on this occasion.

Professor Talbot’s reply

“I agree that this does point to a frequent dilemma. In this case, I think the issue is rather more about Cameron’s flip-flopping leadership style vis-a-vis delegation. He started out not wanting to engage with detailed policy and leaving that to ministerial teams, but as soon as the political going gets tough (e.g. forests, and now the NHS) he suddenly jumps in and takes over, often quite brutally.

I think this is a good example of doing the right things at the wrong time. He should have been involved at the start, making sure the health policy was right, and then left Lansley to get on with it and backed him all the way. Instead he left Lansley to it and it’s clear that Cameron was unaware just how radical the plans were until it was too late. Initially he tried to throw some political capital behind them (his speech in January) but then he realized it was not going to work and now he’s had to jump in with both feet and effectively take over the policy. Lansley is now so badly damaged few expect him to survive a summer reshuffle. And the political damage to the Coalition, and especially the Tory brand, is considerable.”

We are also listening

As ever, subscribers to LWD are invited to join in the discussion.

3 Responses to Colin Talbot on Health Policy

  1. A P Cameron says:

    If Cameron had been involved early, the policy might have not been substantially different, and he would have found it more difficult to distance himself from the reforms. The delegative approach leaves Ministers taking the risk and allows Cameron to step in when things get rough. I imagine that there will now be much greater effort from Ministers to establish that No 10 is on board when new policy is being launched.

  2. Tudor says:

    From APC about DC.


    The dilemma of delegation! I trust you to get on with things (but trust me to step back in if things seem to be going wrong)?

    Hard to imgaine what gets discussed in cabinet. We’ll have to wait for the memoirs (or leaks).

  3. A P Cameron says:

    Yes, the dilemma of delegation! It has certainly gone wrong, and with hindsight a more consultative approach would have been a better fit with what the Tories said about their policy towards the NHS prior to the election. I find it hard to believe, however, that Cameron did not know how radical Lansley’s proposals were given his own experience of and interest in the service, the huge amount of briefing he would have received and his rather late intervention. My hunch/perspective is that Cameron decided to take a calculated risk and he gave Lansley opportunity to retrieve the situation himself which he failed to take. Is that flip-flop or flexibility? As you say, we will have to wait for the memoirs.

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