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Gordon Brown used the word “change” eight times in his first brief speech outside number 10 as prime minister, and for the Department of Health it has been almost “all change.”
An almost completely new ministerial team enters the department, with Alan Johnson, the former education secretary, as secretary of state, and Sir Ara Darzi, professor of surgery at Imperial College and already the health department's surgical adviser, joining the House of Lords to be a junior health minister as part of the prime minister's “government of all the talents.”
Dawn Primarolo, the only minister to have served as long as Gordon Brown at the Treasury—as financial secretary up to 1999 and since then as paymaster general, having worked closely in Mr Brown's Treasury team in opposition before that—becomes minister of state. So does Ben Bradshaw, one of the first openly gay MPs, who at 36 years old has been promoted from junior minister in the environment department, where he has been “minister for bird flu.”
The junior ministers are Ivan Lewis, social care minister for the past year, who is the one Commons based survivor from the previous regime, and Ann Keen, a former district nurse, nurse tutor, and general secretary of the Community and District Nursing Association. She is seen as a Brown loyalist gaining her first ministerial appointment.
How far all this also means “change” for government policy on the NHS remains to be seen. Ministerial responsibilities—who does what—had not been assigned as the BMJ went to press.
A change of language and tone looks certain. Mr Johnson, in contrast to his predecessor, has an easy style and fine line in self deprecating humour. Briefly touted as a leadership contender last September during the “anyone but Brown” frenzy within the Labour party, the former education secretary has been seen as a Blairite who managed to stay in touch with Mr Brown. As education secretary he has pursued the government's “modernising” agenda in education, which included bringing in private money to state schools through the city academies programme.
As a minister of state he was credited with having the fluency and charm to get Labour's highly controversial introduction of higher university tuition fees through against a big backbench revolt when Charles Clarke was education secretary. He declared afterwards, “I was the charm; Charles was the offensive.”
During the Labour deputy leadership contest he called for a “proper dialogue” with health workers, saying that the government may have “listened a bit too much to the BMA and not enough to unions like Unison. Maybe what we should be doing is bringing the unions in the health service much more closely into social partnership.”
The appointments of Ms Primarolo and Ms Keen, neither of whom would be seen as natural supporters of the Blairite agenda of choice, competition, and use of the private sector in the NHS, are likely to be seen by some as a signal that the current reforms may be slowed or even reversed. Ms Primarolo's first frontbench post in opposition was a deputy to David Blunkett on health between 1992 and 1994, when Labour policy was virtually outright opposition to the Conservative party's internal market.
But that was 15 years ago, and the appointment of Professor Darzi, a highly distinguished clinician who is in the main a supporter of the current reforms, can be read the other way. If history is anything to go by, however, it is usually the secretary of state and the prime minister who settle the direction of travel not the more junior ministers.