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By Paul Goodman
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Screen shot 2013-05-17 at 07.59.52The Financial Times this morning reports the conduct of a Cabinet Minister who arrived at his Department in a position of strength. Philip Hammond is digging in over cuts to his budget.  Meanwhile, the Daily Mail reports the plans of another, who came to his Department in a position of weakness.  Jeremy Hunt is planning for prescriptions to be available online.  The latter Minister is more exposed to public wrath than the former. Rightly or wrongly, voters are more concerned about the NHS than defence, and the Conservatives have long been targetted on the health service by their opponents.  Remember Tony Blair claiming in 1997 that Britain had a fortnight to save the NHS?

Tim Montgomerie set out on this site last year how the Health Secretary aims "to be angrier than any voter at NHS failures".  But Hunt's plan to champion the interests of patients is only part of his larger strategy to improve the health service – and, in the process, leave the Department stronger than when he arrived. To understand it, it's essential to grasp that the NHS is experiencing the tightest financial squeeze in its history: its budget may be protected, but the rise is planned to be 0.1% a year until 2015.  Like other western countries, Britain is experiencing a rise in the number and proportion of older people, and is struggling to contain the health costs that follow.


Hunt thus faces the possibility, even the likelihood, of an NHS crisis on his watch, complete with hospitals closing wards, ambulances parked outside A & E departments, shroud-waving NHS staff – and David Cameron's pledge that he'd cut the deficit, not the health service, exposed to attack from Ed Miliband and Labour.  The NHS is striving to find £20 billion in efficiency savings by 2015 at the same time as meeting that rising demand: already, it has carried out 400,000 more operations a year since the Coalition was formed.  But Hunt won't be able to square the spending circle and better the health service without tackling one of the roots of the difficulty.

Very simply, more people are turning up at A & E departments – in particular, older people.  Both their problems and those of the system run far deeper than what happens at A & E.  But governments are peculiarly vulnerable to what happens to hospitals, and the Health Secretary must thus pay special attention to the causes of the rise.  One of them is that doctors aren't treating patients in the way that they used to.  Hunt traces the cause back to Labour's GP contract of 2004, which sources close to him say was "the start of the rot".  The targets set by the contract boosted, say, immunisations – but the quality of patient care declined.

This is because doctors who are constantly chasing after targets can't simultaneously get to know patients in the way they used to – their particular illnesses, their history, their quirks and habits.  As a result, according to those sources, "GPs surgeries have become mini A & Es", and if older people and others aren't satisfied with the treatment they get there – or can't get in at all at weekends – off they will go to the nearest A & E department.  The Health Secretary wants one doctor to be responsible for each patient's care.  He or she might not be available to treat that patient at weekends in emergencies – but should be able swiftly to pick up the threads of a case.

The Mail's prescriptions story today is part of Hunt's plan.  He wants online booking for appointments to be in place by 2015, and patient computer records to be transferable across the system, with each patient's individual consent, by 2018.  By the time of the next election, he hopes that the latter scheme will be working in at least one NHS region.  This better booking and information flow will, he hopes, improve care and prevent unnecessary hospital treatments – thus freeing beds and bookings at a time when the system is under growing strain.  The Department claims that no new expensive computer system will be needed.

Hunt could simply have been swamped by the system after arriving at Health.  Instead, he has worked out a plan both for it and himself.  Part One is to be the voice of the patient against the system.  Part Two is to improve the efficiency with which the system works – while boosting the quality of care.  It is vulnerable to derailment.  The Mid-Staffs horror hasn't been easy for Hunt: many Conservative backbenchers believed, quite rightly, that David Nicholson should go as a result.  And between the start of negotiations on the GPs' contract this autumn and their conclusion next spring lies winter – one that could see that NHS crisis happen.

None the less, Hunt may just get through to 2015 without one erupting on his watch.  If he does, I suspect that he will have more than recovered from his setbacks over Leveson.

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