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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 July 14; 335(7610): 71.
PMCID: PMC1914475

Can the ex-postman deliver?

Nicholas Timmins, public policy editor

Alan Johnson has come a long way since his years delivering letters. Nicholas Timmins examines his career and asks whether he can deliver NHS reform

Alan Johnson arrives as secretary of state for health charged with pouring oil on troubled waters. How far the current beneath them will continue to flow in the direction of Tony Blair's market-style reforms to the National Health Service—with choice, competition, and the private sector being seen as the key to improving services—remains to be seen.

The 57 year old former postman and trade union leader brings an easy style and a fine line in self-deprecation to the job. He has a reputation for being a Blairite who also gets on with Gordon Brown, although the new prime minister has given him what may seem to be a somewhat thankless task.

General secretary of the Communication Workers Union at the age of 42, he was about the only trade union leader publicly to back the dumping of Labour's clause IV—which committed the party to nationalisation—during Tony Blair's and Gordon Brown's construction of New Labour ahead of the 1997 general election.

Rapid rise

Entering parliament as a Hull MP that year, he instantly acquired the most junior of government jobs as parliamentary private secretary to Dawn Primarolo, financial secretary to the Treasury. She is now to be Mr Johnson's junior as minister of state for public health. Two years later he began a whirlwind trip through six ministerial jobs in seven years, starting out at the Department of Trade and Industry, through education, on to being secretary of state for work and pensions, and back to trade and industry as secretary of state before becoming secretary of state at education and skills in 2006, where he pushed ahead with city academies and other private sector involvement in schools.

For a brief period last September, when Tony Blair's supporters in Labour's ranks were going through an “anyone but Brown” frenzy, he was touted as a possible contender for the Labour leadership contest that never happened, opting instead to run as deputy leader and losing narrowly to Harriet Harman.

His biggest single achievement as a minister has probably been the deployment of his undoubted charm on Labour backbench rebels in 2004 to get the government's controversial introduction of higher university tuition fees through the House of Commons. Working with Charles Clarke, the then education secretary, he famously remarked afterwards that “I was the charm and Charles was offensive.” His least notable achievement, certainly in the eyes of some colleagues, was when he was handed the problem of sorting out—that is, cutting—the future cost of public sector pensions. He took colleagues aback by agreeing with little consultation that all current staff with a retirement age of 60 should be able to keep that, when emerging government policy on the state pension was to see it pushed up from 65 to an eventual 68. He vigorously argues that the deal he did will still deliver the bulk of the savings the government was seeking.

He is one of Labour's relatively few “log cabin to White House” politicians, orphaned at 12, brought up by his 15 year old older sister, starting as a Tesco shelf stacker before delivering the post to Dorneywood—the ministerial grace and favour residence near Slough—and bringing up three children on a council estate before becoming a union official and eventually a minister. While at the education department he had a T shirt on his desk declaring: “I went to a London state school [Sloane Grammar in Chelsea, which he left at 15] and all I got was a place in the Cabinet.”

But while he is happy to be known for rising from working class roots, it is not something he trades on. And though he may be a trade unionist by background, he is, in Roy Hattersley's phrase, someone “with whom most trade union leaders disagree.” He pointedly said some of them seemed to be on day trips “to the planet Zog” for still wanting Baroness Thatcher's reforms to trade union law repealed.

Safe hands?

The biggest unanswered question about him is probably whether he has the focus, drive, and attention to detail needed to put through the remainder of the Blairite reform programme, which still needs big decisions on how the system is to be regulated if it is to survive. The speed at which he has changed jobs since 1999 means there is little on which to judge his ability to do what the Blairites called “delivery.”

The unsurprising message from 10 Downing Street, and indeed from some of those most closely advising the new health secretary, is that his brief is to stick with the reforms but do them more quietly. Gordon Brown's office is eager not to see headlines about U turns, which the Conservatives would be only too keen to exploit.

But already there has been a small, but potentially important, policy shift with Mr Johnson declaring that the remainder of the second wave of independent treatment centres will be set up only where the NHS clearly needs the capacity. That is a step back from the previous approach, which saw part of their role being to provide competition for NHS trusts and other private operators, while helping create a viable market for the private sector supply of treatments to NHS patients. The extension of choice—which Mr Johnson said in his first press conference will continue to be rolled out—may have overtaken the need for them.

Meanwhile, Mr Johnson has dumped comprehensively on his predecessor Patricia Hewitt, conceding the professions' claims of low morale and a sense of being overwhelmed by “top down” changes that seemed ideologically driven. Professor Sir Ara Darzi has been dispatched to try to win staff and public engagement. The new health secretary will talk much more about things that Gordon Brown's government believes patients care about—access to services—rather than reforms to incentives and structures. His appointment tells us that the language will change. Whether the policy will remains an open question.


Competing interests: None declared.

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