Extended web version: ‘We need to be ready for two years of recession’

Opposite Alan Johnson’s desk is a plaque from the Chinese health ministry — a gift that must, at times, seem like a taunt. The Health Secretary controls 1.3 million staff, more than anyone bar the commander of the Red Army. His £120 billion budget is greater than any government department in Beijing. The Chinese economy and the NHS were both subjected to limited market-based reform — yet there the similarities end. Deng Xiaoping succeeded. Tony Blair was ousted. And now Mr Johnson stands in charge of the largest bureaucracy on the
planet.

We have heard strikingly little about health since he took over, which he regards as a success. The Blairite health reform agenda had led to the most bitter feuding in government — at one stage, a Gordon Brown doll was dangling from a noose at one desk in the health department. His predecessor, Patricia Hewitt, latterly needed bodyguards when she went to speak to nurses. Now the ever-smiling Mr Johnson has calmed the department. The reform agenda has not died, he argues — it has just been rephrased.

‘The task we set ourselves was to change the language,’ he says, reclining in his office sofa. ‘You have to find a way of talking that takes people with you. Before it was all managerial-speak — practice-based commissioning, payment by results and all of that. It’s not language that people relate to in the health service.’ Surely it is more than that, I ask: what about those cancelled contracts for the private clinics that had been expected under the Blair years to carry out up to 10 per cent of operations?

His answer is fascinating. Contracts were cancelled, he said, because they were not needed: the very threat of competition unblocked NHS bottlenecks. ‘When you introduce these [private] centres, you find that performance suddenly zooms in the local NHS hospitals that had previously said they couldn’t do any more hip replacements,’ he says.