Demise of the DHSS
Authors: J. Warden
Journal: BMJ (1988)

A wretched six months for  DHSS and its chief, John Moore, culminated in last week's parliamentary frisson over housing benefit. That, of course, followed seriatim on  frenzy about health funding. In  past half year there has been scarcely a week when  DHSS and its ministers were not in  line of fire, to say nothing of  flak directed at  Prime Minister. So far, however, Mrs Thatcher has given no overt sign of displeasure with  DHSS or of any wish to dismember it. She dislikes meddling with  machinery of government or moving desks around. Activity for its own sake is not her style, and she has proved equally indifferent to  socialist origins of  DHSS. Yet  threat to  department's survival is real enough, emanating more from  Treasury, which has had to come to its rescue three times in quick succession: firstly with ?100m extra for  health service last December, then with another ?749m in fully funded pay awards last month and  ?100m of restored welfare benefits last week. The political cost has been just as heavy. Mrs Thatcher has been forced into two major reversals of policy. She is having to preside over a review of  NHS that she did not want, and she has made concessions on housing benefit that she had flatly refused to contemplate two weeks earlier. She was responding to  anxieties of Conservative MPs, which were assiduously fanned by Labour's harrowing recitals of dying babies and impoverished pensioners. It was one of those situations where  government could not win. To do nothing would seem hardfaced; to concede would look like weakness. But while  government can probably survive  episode unscathed  hapless DHSS has been digging its own grave. The health row was embarrassing enough, but another on social security is inexcusable. The Conservative party is unforgiving of ministers who do not seem up to  job. Last week not only Mr Moore but his entire ministerial team were in  doghouse. In charge of a dual ministry, they had shot  government in  foot with both barrels simultaneously. There is some sympathy for Mr Moore in so far as he was dealing with problems inherited from his predecessor, Norman Fowler, whose six years at  DHSS amply justify his reputation as  Teflon man. Now, however, most Tories think that  time has come to break up  DHSS. They are under no illusion that it has won anything more than a temporary breathing space; another relapse seems inevitable. Few believe that  funding of  health service has been solved or that all  hard cases of  social security system have been covered. A departmental budget exceeding ?60 billion and problems of similar magnitude are too much for one minister to handle. In political and practical terms  arguments for separating  health and social security functions have become compelling. Mrs Thatcher has learnt  hard way. The conglomerate DHSS was  political brainchild of Richard Crossman, who conceived it as  powerhouse of all state social services, which it has never been. Crossman was working on his plans at this time 20 years ago and  DHSS came into being six months later. It is interesting to recall that on his first visit to its prospective headquarters at  Elephant and Castle in April 1968 Crossman noted in his diary that the big political problem is that  doctors have been turned down in their demand for an increase of pay by  Kindersley Committee, but this is a crisis I shall certainly leave to Kenneth Robinson (the health minister). At  same time  Labour government embarked on a series of crisis spending cuts, health charges, and increased taxation. (By contrast, Mrs Thatcher can at least claim that her government is able to meet  extra costs for doctors' and nurses' pay only because  public finances are strong.) Meanwhile, having created  monster DHSS, later Labour administrations attempted to control it by including its two top ministers in  Cabinet. It was not, therefore, surprising to hear opposition peers call last week for  return of  Minister for Health to  Cabinet. By a freak parliamentary coincidence  suggestion was being voiced in  Lords at  very moment when  embattled Mr Moore was digging himself out of a hole in  Commons. The peers, debating  Acheson report on public health (23 January, p 303), sighed not only for  return of medical officers of health but also for a full minister for health, a change that would restore NHS morale. Lord Skelmersdale,  junior health minister, could do no more than promise to pass on  comments to his superiors. Nor was he able to give any insight on  government's thinking about  Acheson report. In a throwaway remark on  health risks of cigarette smoking  minister thought it necessary to reiterate as a principle of  NHS that people should not be assessed and charged according to  extent to which they had contributed to their ill health. There were many illnesses connected with people's lifestyle, he said.