By Tim Montgomerie
Follow Tim on Twitter
I suspect there would be little argument with the proposition that George Osborne is the most important member of David Cameron's ministerial team but who has the second most important job? You could argue it was IDS. He's making landmark reforms to welfare and is responsible for delivering the biggest cuts of the deficit reduction programme. There is an argument for Michael Gove because of the scale and reach of his education reforms. Or what about Theresa May? She is responsible for flagship immigration, police commissioner and security policies. My argument, however, would be that Jeremy Hunt can probably claim to have the second most important and difficult job in the current government.
The first reason is that he leads the NHS at a time when it faces the most difficult financial settlement in its history. Throughout nearly all of its life it has received inflation-busting increases in its budget. Those increases have helped it to keep pace with the cost of caring for Britain's ageing population, the growth of lifestyle-related diseases and the higher-than-average rising costs of new drugs and other medical technologies. During this period of austerity the NHS is going to have to cope with inflation-only increases in its resource allocation. Not for one or two years but for perhaps five or six. It will only cope if it makes unprecedented economies including the amalgamation of certain facilities and greater specialisation. A report in today's FT (£) underlines the scale of the task. Reporter Chris Cook notes that the Nuffield Trust believes that "Britain’s ageing population, salary pressures and drug price rises could cost the NHS a further £34bn by the start of the next decade".
Reason two is the politics. In opposition David Cameron achieved the almost impossible for a Tory leader and neutralised the party's long-standing disadvantage on the NHS. Sadly that advance was thrown away in the first half on this parliament by the decision to undertake NHS reforms that were unheralded and unnecessary. Worse than unheralded we had specifically promised no major reorganisation of the NHS. They were also unnecessary because – other than the uncontroversial reforms to community care – nearly all of the changes that Andrew Lansley wanted did not need primary legislation. The result of the last two years of turmoil is that Labour has reasserted its traditional polling lead on the NHS. Lord Ashcroft's recent mega poll found that by 38% to 26% voters felt that the NHS would fare better under a Labour government. During the recent Corby by-election healthcare was the one issue that really moved votes. Labour's "550 beds could go" scare campaign was crude but all too effective.
John Major and Margaret Thatcher couldn't persuade voters that the NHS was safe in their hands and – for most of their time in office – they could throw money at the NHS. What chance does Jeremy Hunt have at succeeding?
His first advantage is that much of the NHS doesn't make great use of its existing budget. It has enjoyed big budget increases in the pre-bust years and different hospitals have made very different uses of that money. Some have become world standard and others have continued to underperform. Jeremy Hunt's big idea number one is to shine a relentless light at these differences in performance. In an article for today's Guardian he writes about how he wants to create a transparent NHS where slow coaches learn from "high-fliers".
As far as I can tell he wants to be the champion of the best of the NHS but the scourge of the worst. In my column for today's Times (£) I note that his model is Michael Gove's school reforms. In the same way that Gove has let go of most of the education system – while subjecting it to enhanced inspection and reformed exam standards – in order to focus on the failing schools, Hunt wants most of the NHS to be self-governing with clinicians in charge. In a way this only acknowledges the new reality. Greater independence of operation was the logic of many Blairite reforms and those were accelerated by Mr Lansley. Hunt is probably the least powerful Health Secretary in the NHS' history in terms of control of the organisation's levers. An assortment of bodies including GPs, devolved hospitals, the NHS Commissioning Board, Monitor and NICE all have the power today that his predecessors enjoyed.
So Hunt's big idea two is to become the relentless champion of the patient. Anticipating the anger that many NHS patients are going to feel at service failures over the next few years he is aiming to be in the vanguard of patient protests. By doing so he hopes that it won't be him that gets the blame for any failings but it will be individual parts of the health service. His argument will be clear. If Lower Snodbury Hospital can flourish on exactly the same budget it is not excusable that Upton Snodbury Hospital cannot.
Standards of personal care are Hunt's first target. In a speech to the King's Fund last week he was more damning of failures of care than any minister I can remember:
"Rather than minimising some of the NHS’s problems, he sought to inflame them. He presented himself as able to match the anger of any unhappy patient. He noted “how patients were left to die in their own excrement in Stafford hospital”. He talked about “a coldness, indifference, even contempt” towards patients that existed in places such as St George’s Hospital, Tooting and the Winterbourne View care home. Were failures isolated incidents? “Sadly not,” was his reply. Cruelty had been normalised. The unacceptable had been legitimised. The callous had become mundane."
Read more in my Times column (£).
Finally a word about Jeremy Hunt's year…
At the very start of this year Jeremy Hunt offered what
appeared to be an enormous hostage to fortune. Speaking to a ConservativeIntelligence reception for Tory
MPs, journalists and business leaders he argued that if deficit reduction was
the supreme test of the Coalition’s resolve then the Olympics Games would be
the supreme test of its competence. Lifting a glass of wine towards Mr Hunt one
of Radio 4’s best known voices shouted a thinly disguised threat: “We will
Only months before the world’s biggest logistical event it
was an audacious thing to say and you can be sure that Mr Hunt would have been
reminded of it if there had been transport chaos, security blunders or medals
failure. But, of course, there weren’t. Again and again the Government took
important decisions that helped to make London 2012 the enormous success that
it was. Not least, despite tabloid moans, Hunt doubled the budget for the
opening ceremony. Without that decision Danny Boyle would never have been able
to deliver the jaw-dropping spectacle that presented such a captivating image
of Britain to the world.
Hunt delivered despite being subject to one of the biggest
media onslaughts of recent times. Again and again in the months running up to the
Games he was accused of improper relations with the Murdoch empire over his
role in managing the BSkyB bid. None of the Labour MPs who bayed for his blood
at the time have apologised for the attacks on his character that Lord Justice Leveson
has now judged to have been unfounded.
Almost every pundit wrote Hunt’s political obituary
but in September’s reshuffle David Cameron gave the strongest possible signal
that he, not Fleet Street, would choose his Cabinet. Few expected Hunt to become Health Secretary; least of all Hunt himself. He is under no illusions, however, about the task ahead of him. The Olympics was hard work. Leveson was gruelling. Overseeing the NHS will be his greatest challenge.