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HUNT Doctor Carla Millar

Some of the most interesting stories are about events that never took place – the interest being in why they didn’t.  At the end of last year, the Government was facing a double crisis as soon as the new one began.  Its first component was the mass of Romanians and Bulgarians expected to enter the country from January 1.  The second was an old-fashioned NHS “winter crisis” – complete with wards full up with patients, ambulances with terminally-ill patients stacked outside A & Es, protesting nurses, condemnatory doctors, opportunistic Labour politicians, plummeting Conservative poll ratings – and grieving relatives confronting a “besieged” and “embattled” Health Secretary, Jeremy Hunt.

The conditions seemed to be right for one.  NHS spending is rising at 0.1 per cent a year.  His Cabinet colleagues may envy Hunt the relative protection of his budget, but he is presiding over the lowest rate of spending increase in the NHS’s history.  Furthermore, many people who need treatment are unwilling to go to their GP or wait for an appointment. They want to be treated now – and that means a visit to A & E: 1.2 million more people are using A & Es each year than was the case three years ago.  The previous winter, 2012-13, had been a bumpy one for the NHS.  And the Strategic Health Authorities, which used to oversee hospitals’ A & E management, had now been abolished.

Labour tabled a Commons debate on Accident and Emergency; the BBC devoted part of its website to “NHS Winter”.  “Tell us if you or a relative or a friend has recently been to A&E,” it said. “How long did you have to wait for treatment? How well were you treated?”  There were similar questions for NHS staff.  The tumbril was being prepared for the Health Secretary.  So how come a “crisis” never forced its way to lead the news bulletins and front pages, George Osborne didn’t have to “step in” to “save” the service with “a fresh injection of resources”…and Hunt remains intact?  Indeed, he is thriving – at least, if the ConservativeHome Cabinet members league table is anything to go by.

One ready-to-hand answer is: it didn’t snow.  NHS insiders are sniffy about this explanation, arguing that older people tend to stay indoors more during very cold weather, and that claims of them being more vulnerable during it are exaggerated.  The circle around Hunt tends to think that the truth lies between the two extremes.  Unsurprisingly, it is resistant to what it sees as Labour-driven claims that “the Prime Minister took charge” (though he certainly chaired at least one meeting pre-Christmas at which Health Department officials were present) or that a ruffled Health Secretary was persistently on the phone to managers in the creakier hospitals.

Certainly, Labour had a Catch-22 trap ready for Hunt.  If he had left those managers well alone, Labour would have been portrayed him as a “hands-off” and “aloof” Secretary of State who “doesn’t care about the NHS”.  Since he didn’t, the best alternative to hand is to label him with a series of adjectives beginning with “rattled” and ending with “hysterical”.  Hunt’s friends point out that he has taken a detailed interest in the NHS from the start, manning desks at G.P receptions and doing shifts as a hospital porter.  “It’s not just a matter of phoning managers of hospitals that are in trouble,” one said, “It’s also important to ring and praise those who are doing well.”

The version of events from the Department of Health is that panic measures wouldn’t have prevented a crisis in any event: that what matters is ensuring that A & E departments work as well as it can – and that there is a plan for the long-term to ease hospital admissions.  Hunt’s team says that there are some 350 more doctors in A & E and that the average wait to be seen has come down – as has the wait for treatment (in the former case, 33 minutes compared with 77 minutes; in the latter, 75 minutes compared with 102).  NHS statistics are notoriously contestable.  But resources have undoubtedly been concentrated on A & E.

The Health Department has also changed the way in which money to cope with winter demands is allocated.  Previously, it was distributed in November, and spread evenly across all hospitals.  Last year, £250 million was sent out much earlier – in September – and concentrated on the 53 hospital trusts that were judged to be most in need of help.  One source told me that under the previous dispensation some of the money was often used simply to improve hospital balance sheets.  It was decided to sweep this arrangement away and target the money. This change seems to have helped to steady the hospitals’ collective ship.

What matters just as much as speeding up treatment in A & E is ensuring that there are beds for those who need them to go to – and that means being able to discharge patients from wards safely.  The Department’s view that the best hospitals are those that work on a plan to do so in each case right from the start, almost from the moment the patient is admitted.  This is why another feature of Hunt’s efforts to avoid that winter crisis was striving to improve the join between some hospitals and social care.  And better than moving people through hospital as quickly as possible is not having them in it at all.

The aim of a key pillar of the Health Secretary’s policy is to keep people out of hospitals altogether through more effective health and social care treatment.  His friends claims that a patient who has his own GP is a patient less likely to need hospital treatment: the relationship is good for peoples’ wellbeing.   Hence Hunt’s drive to ensure that this happens, both in hospital and out of it.  At any rate, the headline-grabbing drama of an NHS crisis didn’t happen this winter – contrary not only to others’ expectations but mine.  I have been anticipating one since before the NHS Bill, and thus admit that, to date, I have got it wrong – though of course there is still one more winter to go until the election.

The lesson is applicable elsewhere.  The BBC has reported Labour’s bungling of managing the NHS in Wales that both Hunt and Charlotte Leslie wrote about on this site last week.  (Waiting times in Wales are now at their highest for two years.)  But it hasn’t devoted a whole section of its website to the story, as it did to the NHS in winter, together with a Facebook page and a Twitter tag.  It geared itself up more for something that didn’t happen than for something that actually did.  It should be more cautious next time round.  If a crisis happens next year, after all, the BBC will be free to cover it – as will everyone else.

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