If the Conservatives win the general election, Jeremy Hunt wants to carry on being Health Secretary. He says that changing the culture of the NHS is “a life’s work for any politician”, which is why he has told David Cameron: “I’d like to stay in this job.”
Hunt’s account of the changes the NHS needs will irritate free-marketeers who believe privatisation is the way forward. According to Hunt, “It’s not about public versus private. It’s about good care versus poor care.”
Labour accuse the Conservatives of wanting to sell off the health service. But in Hunt’s view, “it’s a big mistake to be ideological in health”, and it is Labour politicians who are imprisoned by their own ideology.
People like Hunt’s opposite number, Andy Burnham, have such a profound belief in the virtue of the state-owned, state-run NHS that they have become “complacent” about the “culture of cruelty” which was exposed at Stafford Hospital. Instead of defending individual patients, they end up defending the system.
Hunt says that as long as he can convince NHS staff that what interests him is high standards of patient care, he never has any difficulty in getting on with them. But he recognises that some on the Left still regard him with deep suspicion: “the fact that Polly Toynbee hasn’t written about me for six months is probably the closest I can get to an acknowledgment that I’m not all bad”.
At the end of this interview, he describes himself as “a frustrated classicist”, with a yearning to learn hard languages. When he chooses, he is also, unfortunately, a master of the language of present-day government (“safe, compassionate care in a modern era”), some chunks of which have been removed from what follows.
Hunt’s insistence that he wishes to continue as Health Secretary (first made to Health Service Journal), came in response to a question about something completely different.
ConHome: “Who are your political heroes?”
Hunt: “My political hero, without any doubt at all, is Wilberforce. He was never a minister, and it took him 18 years to persuade Parliament to abolish the slave trade. He happened to be friends with Pitt, which was quite helpful, but he stuck at it for 18 years, and he chose to do not lots of little things, but one big thing…
“I do genuinely think that if you can take something as big as the NHS, and can replant the seed of what every doctor and nurse wants from the NHS, which is safe, compassionate care in a modern era, that I think is an absolutely huge achievement. And I’m not there yet, but that’s why I said to David Cameron I’d like to stay in this job if he wins the election.”
ConHome: “What did he say to you?”
Hunt: “He smiled in that enigmatic way that Prime Ministers are famous for when people start talking about jobs they might have in future.”
ConHome: “When did you last have a serious argument with someone? In the profile I wrote of you for ConHome, I suggested you’re the kind of Englishman who has ‘a compulsive desire…always to remain on good terms with people’.”
Hunt: “Yes, I’ve thought about that, and I think there is an element of truth and something that is wrong about that. Sue [Beeby, his special adviser] is now looking very worried.
“I was really interested that you wrote that. Because I think actually socially you are absolutely right. So socially I have that public school thing where you basically, you kind of want to be chummy with everyone, and on good terms, and there’s a kind of thing where it’s sort of slightly bad form to fall out with people, and I’m sure I’ve got that, a quintessential English quality in a way.
“But in my own case I think what it belies is the fact that I have very clear bottom lines. And I think if you talk to any of my colleagues in government, and I’m not one to divulge the big battles I’ve had, but I think this is my private office and they will tell you that every week it battles with different parts of government.
“I don’t think you could say that from all the legion of mistakes I’m sure I’ve made as a minister and before I went into politics that I’m someone who’s taken the easy path in the decisions I’ve taken. In the NHS I am the first Health Secretary who has spoken out publicly about poor care in the NHS. I’ve talked about a ‘culture of cruelty’ in parts of the NHS.”
ConHome: “No one’s done that before?”
Hunt: “No one’s done that before, and I think it’s changed the terms of the debate on the NHS, because I think now people are talking openly about problems in a way that didn’t happen before. As Health Secretary I write a personal letter to a patient where something’s gone wrong every single day. It’s the first thing I do when I arrive.
“Which might sound a bit depressing, but it’s a bit like the canary in the emperor’s ear. It’s really important that there is someone who’s reminding the person at the top of this massive pyramid of 1.2 million people that sometimes things go wrong. And you can’t be the defender of the system. You’ve got to be the champion of the people who depend on the system.”
ConHome: “The media – which of course finds it a good deal easier to report bad news than good news – hasn’t yet managed to declare a crisis this winter. Why do you think that is?”
Hunt: “Well there is no Oxford English Dictionary definition of what constitutes a crisis in the NHS. It’s a completely subjective thing. What is a fact is that the NHS is under huge pressure, and it’s under more pressure this winter than it’s been for many years…
“The most disastrous thing the last government did was they got rid of GPs being personally responsible for patients. That fundamentally breaks the accountability between doctor and patient, which is the reason many people became GPs.”
ConHome: “Did you ever discover why they did that?”
Hunt: “It was just bad negotiating. From next April everyone will have their named GP. This is a really important part of changing the culture of the NHS.”
ConHome: “Is the NHS managing to recruit a sufficient number of GPs?”
Hunt: “We need many, many more. We’ve got plans to train 5,000 more GPs over the next Parliament. There’s no doubt that the big policy mistake of recent decades has been concentration of resources in hospitals, and not enough resources going into the care you provide outside hospitals.”
ConHome: “So where are we getting to on health and social care integration?”
Hunt: “We’re doing it. From April we will be putting £3.8 billion of government money into a joint fund between the health and social care systems.
“There actually isn’t any blue water between the political parties on that. We all agree that you can’t look at the social care system differently to the health care system. Where I think there is very, very big difference in approach is …if you don’t get the culture of the NHS right, where every single patient is treated as an individual…”
ConHome: “But everyone would believe in that. What is the difference between Labour and the Conservatives?”
Hunt: “I am the first Health Secretary who has made it a major priority to say we should not have a thousand avoidable deaths a month in the NHS. Every week I publish the previous week’s Never Events. This is where a hospital has operated on the wrong part of someone’s body.
“As you can see [he points to a board on the wall of his office], the top one there, Countess of Chester Hospital, did wrong site surgery, because they operated on the wrong part of someone’s body. We operate on the wrong part of someone’s body once a fortnight across the NHS on average. So that is a really big culture change.
“And I think Labour have always felt uncomfortable with this, because for Labour it’s always been, ‘Well if you believe in the ideal of the NHS, and that it’s making health care available equally to the whole population, then sometimes things are going to go wrong, but we shouldn’t worry too much about that, because the ideal is right.
“And that complacency is what led exactly to Mid Staffs. The thing about Mid Staffs that is so shocking is not that it happened, because I think you could go to any country in the world and find an example of poor health care, but that it went on for four years without anyone blowing the whistle.”
ConHome: “In the politics of health, from a Tory perspective, it is extremely annoying that there’s this distrust of private initiative, even though private initiative has given us things like the hospice movement in modern times, and of course a great deal of our whole health system in more ancient times.”
Hunt: “I think it’s very straightforward. It’s not about public versus private. It’s about good care versus poor care. Look at the chorus of people on the Labour side, from Alan Milburn to Ara Darzi, who all say that once you make the argument about anything other than whether the quality of care is good or not, you’ve lost the battle, because you’re basically saying that the NHS is about ideology, it’s not about the highest standards of care for patients.”
ConHome: “So you in fact are not ideological.”
Hunt: “I think it’s a big mistake to be ideological in health. If you have a Tory Health Secretary who says we should have more private health care, the public will say, ‘Well that’s for ideological reasons, that’s not because we care what’s right for patients.’
“If you have Andy Burnham saying we want more public provision of health care, the public are equally suspicious. They say, ‘That’s ideological. He’s not interested in what’s best for me.’ And I think what our reforms have done is we’ve said we’re actually going to take this decision away from ministers and give it to local GP groups, and they can decide what is in the interests of patients in their areas.”
ConHome: “So in fact the Lansley reforms are under your more tranquil leadership continuing. I was looking at Matthew d’Ancona’s book and he had this rather arresting expression about your predecessor. Some unnamed adviser at the time of this Government’s great health problems said ‘He’s like a mad professor in the shed. We never quite know what he’s doing in there.’”
Hunt: “I heard Bernard Ingham speak once, and he was absolutely fascinating. He said that in all his years of working for Margaret Thatcher, he very rarely ever asked her what she believed. But every day he was telling the press what she believed on everything. He said, ‘I think I can only think of one time in all those years I got it wrong. I always knew exactly what she thought because she was clear about what she believed.
“When you’re responsible, as I am, for an organisation of 1.2 million people, the most important thing is that they are clear what you believe and the message I sent out to them is I don’t want to be buried away in my office, you need to know that what I care about is compassionate care and the highest standards of care for patients, and it’s all about what you’re doing for patients. And what I find – it’s nice of you to use the word ‘tranquil’ – but what I actually find is when you talk about patients, you never have any arguments with doctors, because that is what they believe too, that is why they went into medicine. As long as they think it’s genuine then they’re prepared to engage.”
ConHome: “Much less is written about you now, isn’t it.”
Hunt: “Yes, and that’s probably a very good thing. This is a role that’s so politically hot that it’s very hard for even the fairest minded of Guardian columnists to actually write something reasonable about me, and the fact that Polly Toynbee hasn’t written about me for six months is probably the closest I can get to an acknowledgment that I’m not all bad. Mind you, if you write that, there will be a stinker of an article.”
ConHome: “She won’t think this is at all funny.”
Beeby: “We’ll have provoked her.”
ConHome: “You haven’t really arrived in Tory politics until you’ve been attacked by Polly Toynbee.”
Hunt: “I have been attacked many times by Polly Toynbee. But the broad point is that you have to motivate everyone behind a shared goal, and I think everyone in the NHS does want to look after patients.
“There is a big difference between the NHS and the Labour Party over Mid Staffs. Because the Labour Party resolutely refuses to talk about Mid Staffs. It refuses to accept that they did anything wrong, that they had any wrong policies at all. And Andy Burnham is still telling people this was an isolated local failure.
“Whereas everyone in the NHS will tell you that what happened at Mid Staffs wasn’t isolated. It may not have been as bad at other hospitals but there were pockets of it all over the NHS. And what they’ve done which I think is a remarkable thing is they have united and said ‘We don’t want this in our NHS. We’re going to stamp it out and we’re going to stop it.’”
ConHome: “You said once you learnt the wrong language: you learned Japanese and your wife’s Chinese. Do you now speak some Chinese?”
Hunt: “In my last job I used to do a Chinese lesson once a week. We actually got married in 2009, before the last election, and I used to have a Chinese lesson once a week. But I’m afraid I found I just didn’t have time when I took on this job, so it’s stopped.
“What I am actually is a frustrated classicist. My A levels were Latin, Greek and English, and I should have done Greats [i.e. Latin and Greek] at Oxford, and I sold out and did PPE, like the rest of the Cabinet, and it was a terrible mistake, because I should have done Greats.”
ConHome: “Oh good. I’m glad you’ve admitted a mistake. Boris would really agree with that.”
Hunt: “He’s right, because there’s nothing like Greats. And the bit I enjoyed in PPE was the philosophy, which I could have done in Greats as well. I had this frustration inside myself about not learning a hard language.
“And then if you want to know the gory truth, my first girlfriend was Japanese. She was another student at Oxford. And thanks to her I got quite interested in Japan and then I decided to go and learn Japanese.”
Hunt does not now look frustrated. He looks like a man who has found a kind of political fulfilment in being Health Secretary.