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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 July 14; 335(7610): 100.
PMCID: PMC1914468
Live from London

My brilliant career as health minister

Deborah Cohen, features editor, BMJ

If newly appointed health secretary Alan Johnson is finding his ministerial portfolio daunting, he might want to try his hand at health policy planning on Fantasy Health Minister ( before he makes any bold decisions.

Devised by the odd coupling of the New Statesman and Pfizer, this game gives you four sessions in office to make a difference to the health of the nation, while trying to balance your budget and improve your political standing. Popularity is rated by doctors, nurses, the media, your party, the opposition, patients, the private sector, and unions.

I decide to take the tack commentators suspect Alan Johnson will take—subtly continue with market reforms while trying to appease a disenfranchised workforce and guarantee patients' access to services. Rumours are also rife that given he's sponsored by Unison—they've described him as “someone we can do business with”—he is more likely to pay lipservice to nurses' demands.

So that's exactly what I do–I hire more nurses. This not only reduces the waiting time for patients to get treatment, and reduces the stress and workload of staff, it puts a smile on the faces of the unions, nurses and the voters–patients.

I also decide to fight hospital acquired infections in line with current policy–although at a cost of £3.5bn rather than Johnson's earmarked £50m. Hospitals are cleaner; recorded MRSA outbreaks decrease dramatically; and, I suspect, the Daily Mail will have to find a different axe to grind.

It's not cheap, though, and those nurses have to be trained somehow, so in line with NHS reforms, I employ the private sector to take over the training of some staff. Surprisingly, smiles all round except on the faces of the opposition.

This is only the first step. Pundits are also conjecturing that prime minister Gordon Brown will continue with Blairite reforms to the NHS. Because I'm road testing NHS policy for Johnson, I decide to see what would happen if I fully privatise the NHS—from the New Statesman's perspective at least. The privatisation is messy and expensive, and not entirely successful. Though my running costs are greatly reduced, the process is expensive. Nurses and doctors dislike the new system, but are better paid. Some patients get quicker, better treatment while others fall through the cracks. The private sector, however, is extremely happy.

The prime minister calls to tell me: “Due to the privatisation of the NHS, the healthcare budget will be much smaller during your next session in office. We can use the money you've saved to reduce taxes and fund other departments. Your fellow cabinet ministers I'm sure will join me in hearty congratulations.”

This leaves the opposition short of ideas, forcing the shadow health minister to rail: “Don't re-elect the government that privatised your healthcare system. Give us your vote, and we'll return to a public system.”

If this game is anything to go by, the recipe for a lengthy tenure as health secretary is to charm the media and the unions, cosy up to the medical workforce and gradually involve the private sector. If speculation is correct, Alan Johnson might have it about right.


Des Spence is away.

Articles from The BMJ are provided here courtesy of BMJ Publishing Group