You don’t often hear calls for more managers to solve the crisis in the NHS. But at The Spectator’s Health Summit held in Westminster this week, a panel hosted by Isabel Hardman asking ‘Is the NHS badly run?’ came to that conclusion. Conservative MP and chair of the Health Committee Steve Brine, Labour’s shadow health minister Karin Smyth MP, NHS chief strategy officer Chris Hopson and director of the Reform think tank Charlotte Pickles all agreed that managers might be the answer. ‘The NHS is actually woefully under managed in terms of operational performance,’ said Pickles. ‘And that is an issue. And yes, in some instances you do want clinicians as managers and some you don’t. You want people who are really good managers.’

Who is to blame for the current state of the health service? Does the ultimate responsibility of the service lie with politicians or organisations like NHS England? Pickles pointed to the need for elected governments to have final say over health service decisions. ‘The idea that you should depoliticise the NHS, I think, is ludicrous,’ she said. It being one of the biggest single tax expenditures the country has, ‘of course the electorate must be able to elect a government that sets those, because that’s a very different thing.’ But is the relationship between the secretary of state for healthcare and NHS England a constructive one? ‘There’s a whole lot of conversation as to whether the creation of NHS England was a good thing,’ said Pickles.

‘The structure that is obviously set for the way the health service works is actually set by politicians, and it’s our job to work within that structure,’ Hopson responded, pointing to the need for accountability from politicians ‘in a system in which £160 million of taxpayers’ money is going on the health service’. At the same time, Hopson said, NHS England ‘has to ensure that appropriate value for money is delivered’.

Might a less centralised NHS work better? ‘In every political system, there is always a debate about the degree to which you have central control and local autonomy,’ said Brine.