Appointing outsiders to sort out protective equipment supply, Covid-19 testing and vaccination is a good addition to a fragmented health system, but it is important that their remit and terms of appointment are clear, says Alex Thomas
In the last month the government has tried to solve three of its trickiest coronavirus problems by handing them to new external recruits. Dido Harding is to lead the “test and trace” programme, Paul Deighton to “lead the national effort to produce essential personal protective equipment” and Kate Bingham to chair the UK’s vaccine task force. We can expect to see more of these appointments, with Neil Mendoza also asked by the Department of Digital, Culture, Media and Sport to advise on cultural recovery.
In Westminster parlance these are “tsars”, personal ministerial appointments charged with driving progress and bringing coherence to specific issues. They have long been part of the government landscape, helping to break down barriers between departments and to signal ministerial priorities.
Tsars come in to make up for deeper governance problems
These three appointments suggest that No.10 and the Department of Health and Social Care have become frustrated with the fractured governance of our healthcare system. They want a single accountable individual to crack heads together and make things happen. Harding and Bingham were described on appointment as reporting directly to the prime minister (and cabinet secretary, in Harding’s case), while Deighton was recruited by Matt Hancock, the health secretary, but in practice will need the same authority. All three have extensive experience outside government, Harding in telecoms and retail, Bingham in pharmaceuticals and venture capital, and Deighton in banking.
The profusion of bodies involved in NHS procurement and distribution, and the lack of clarity about who is responsible for making “test and trace” happen, show why a single focal point is needed. When the chief executive of Public Health England tries to rebut criticism from the Science and Technology Committee by distancing his organisation from the very strategy it is delivering, as Duncan Selbie did recently, it doesn’t look like things are running smoothly.
Tsars can be valuable short-term additions to the government
Tsars have tended to be most effective when brought in for a short burst of activity, to mobilise around an issue, and then to retire. A tsar limping on when the energy has gone out of an issue causes more problems than it solves, which is an easy thing to happen when governments appoint so many (180+ between 1997 and 2010, for example). Successful examples include Louise Casey coming in to tackle homelessness during the Blair government – and returning to do the same in recent months, Nicholas Stern’s report on climate change or John Vickers’s work on banking regulation. Others have managed to coalesce debate on an issue, like Andrew Dilnot’s report on social care, but their work ends up sitting on a shelf.
Public and parliamentary accountability of tsars is unclear
There are, however, some longstanding quirks about the status of tsars that could do with being ironed out. There are no rules, procedures or codes which govern their appointment, role or payment. This is valuable to the government, as it allows big figures to be brought in quickly and attracts those who might not otherwise find themselves in government.
But as tsars are not ministers or civil servants, special advisers or non-executive directors, the way they are held to account is too ambiguous. Harding and Deighton both sit in the House of Lords, but as they aren’t ministers they will not answer questions at the despatch box – a source of some concern in the upper house. They can be called to appear before select committees, but are not so bound to face other parliamentary and media questioning.
Insisting on a full competitive recruitment process would be too purist, but there is an opportunity to establish a more direct relationship of accountability between tsars, their minister and parliamentary select committees. The fact that both Harding and Bingham are married to Conservative MPs will prompt questions about their selection and possibly charges of cronyism, whatever their qualifications for the job.
When a minister makes such an appointment, an improvement to the current system would be for them to write to the relevant select committee setting out the tsar’s remit, the length of their appointment and its terms, including payment, and outline how the committee will be updated on their work. That would mean very little extra bureaucracy, no hold-ups or delays, but would establish a clear remit and the conditions for success.
This crisis justifies a flexible and rapid recruitment process. But it does not justify a cessation of scrutiny. Three of the most important jobs in the government’s coronavirus response are now held by rapidly-appointed outsiders. The public should know the terms of their appointment, their brief and the conditions by which their work will be judged a success.