Andrew Haldenby is Director of Reform.
Jeremy Hunt is under pressure. On the second full day of the junior doctors’ strike, his judgement in picking a fight with the junior doctors is being questioned such figures as Alan Milburn. His department may break its spending limit agreed with the Treasury for this financial year. Public satisfaction with the NHS has fallen. The odd rumour is passing around Westminster that he will be moved in the next reshuffle.
Who could blame him for wanting a move? Almost any job in government would be a relief after facing up to the BMA’s gunboat diplomacy every day. But the fact remains that he is a reforming Health Secretary, in a party far too nervous of health reform, and for that he should be prized.
On the doctors’ strike, Milburn said last week that the Government should settle it – get it out of the way because “arguments like this hold up bigger, necessary reforms”. That may normally be the case (and I don’t make a habit of disagreeing with him on public service reform). In this instance, however, the doctors’ representative body, the British Medical Association, clearly see the dispute as a test of the Government’s wider resolve.
Its aggressive rhetoric has raised the temperature and encouraged its membership towards strike action. It would like nothing better than for the Government to back down on what has become a symbolic dispute. Hunt is showing good judgement in holding the line.
He is also right that the NHS should make further steps to join the rest of our 24/7 society (while recognising of course that many staff already work at weekends). When it reported last year, the independent doctors’ pay review body found the “case for expanded seven day services in the NHS … to be compelling”. It noted that, across the economy, 24/7 services have become more prevalent since the 1990s. It said that the NHS would be a beacon of international good practice if it were able to do better.
As Sarah Woolaston has said, the BMA will lose public support the longer it remains on strike. It is interesting that it has decided not to go for a withdrawal of emergency cover, as it originally promised. That is a hint that they fear that they are pushing the limits of people’s sympathy.
On the NHS more widely, he has given full support to a plan from Simon Stevens, the head of NHS England, which would see the NHS change root-and-branch around the needs of the patient. That plan is making slow progress, and the slow pace of change over many years is the reason for the service’s current financial difficulties. Nevertheless, the direction of travel is right and Hunt again has made the right call.
He will now be under immense pressure from within his department to dump the Government’s whole reform agenda in the face of the service’s money problems. He will be urged to settle with the junior doctors, abandon patient choice as a distraction, and take personal command-and-control of the NHS on the model of the early years of the Blair Government. In those days, quite literally, the Department of Health would telephone individual hospitals to see how they were managing their waiting lists. I hope that Mr Hunt resists and that he gets support from the rest of Government.
(Tony Blair latterly sharply reduced the number of central targets and sought to promote competition and choice. This was his view after a decade in office, as told to the Economist in 2007: “The purpose should be so that public services can adapt and adjust naturally – self-generating reform – rather than being continually prodded and pushed from the centre. Public sector unions can’t be allowed to determine the shape of public services.”)
The biggest hope for the future of the NHS is that it becomes more productive by changing the way it does its business. The route to better value lies in preventing ill health, early diagnosis of illness and a unwavering focus on safe, high quality care, all of which is to the benefit of patients. All of this, however, requires political leadership because the NHS workforce will need to change significantly. The Department of Health needs the same strength of purpose that Theresa May has displayed over police reform. Good reformers make waves. Given the BMA, the Police Federation, the Prison Officers Association and so on, it comes with the territory. The waves they make are a sign of their success.
This is not the moment to U-turn on health reform or on Jeremy Hunt.