Jeremy Hunt has been Health Secretary for less than 18 months, and will know less about the NHS than his predecessor, Andrew Lansley – who was appointed Shadow Health Secretary before the 2005 election, became the real thing in 2010, and remained in place until Hunt’s appointment. But the latter’s progress is a reminder that how much knowledge one has is less important than what one does with it. Lansley was battered by health reforms whose aim was as right as his difficulty in communicating it was evident. Hunt had every political reason, when appointed to succeed him, to cower behind his Whitehall desk. He himself had been left bruised by the fracas over News Corporation’s bid for Sky, and the resignation of one of his special advisers, when he was Culture Secretary.
George Osborne is said to believe that the Conservatives’ health policy should be for Tory politicians to say: “We love the NHS” – and, when asked to explain further, to say: “We really, really love the NHS”. This helps to explain why David Cameron proclaimed in 2006 that the health service was his “top priority”: “Tony Blair explained his priorities in three words: education, education, education…I can do it in three letters: NHS.” Cameron was attempting to defuse one of the Conservatives’ big polling negatives – their ratings on health – and achieved quite a bit of success in opposition. The Party campaigned against “Gordon Brown’s health cuts”. Cameron was enthusiastically received by junior doctors. The NHS was his opening campaign theme in general election year, 2010. The service was known to have cared for his disabled son, Ivan, and this family tragedy gave him a moral authority on healthcare issues that his predecessors lacked. Soothing voter suspicions of Tory intentions towards the NHS was incompatible with a health bill that would stir them up again, and which the most important elements of the reform didn’t need, since the shift from Primary Care Trust to GP control of patient care was happening gradually anyway. Hunt could simply have followed Osborne’s advice when he slipped into Lansley’s chair.
His declaration in a speech today that every patient should have a named doctor responsible for his or her care when in hospital isn’t new: he made the same case before Christmas. But it is further evidence of an approach to the NHS which, unlike that of his precedessor, is focused less on systems than on people – when it comes to making his case, in any event. The Health Secretary’s solution to low standards of care in parts of the service, and to their treatment as “a collection of body parts” rather than human beings with names and needs, is more inspection, transparency and information, and thus the driving of change from below as well as above. He himself has compared his programme to Michael Gove’s, though his methods are less confrontational than the Education Secretary’s.
Hence his Quality Care Commission, which mirrors Ofsted; the publication of more performance data; new “deep dive” inspections and his deal with the BMA which reforms Labour’s 2004 GP contract – one which the doctors’ union said had brought “unprecedented bureaucracy and chasing of targets and box-ticking”. The Health Secretary has been a lucky general to date. The service’s budget is ring-fenced. An absence of cold weather has helped to stave off “an NHS crisis” (to date). The stomach-churning details of the mid-Staffs and other hospital scandals have thrown Danny Boyle-style myths about the NHS into perspective. His Labour opposite number, Andy Burnham, is tarnished by his own record on mid-Staffs, which happened on his watch as Health Secretary. And generational change is Hunt’s ally: younger people are less inclined than older ones to see the healthcare system of the 1940s as a model for that of the twenty-first century. Admittedly, it isn’t always clear how the dots in the Health Secretary’s plans will be joined. The Working Time Directive and GPs’ working patterns are obstacles to his respective plans for patient care in hospital and outside it. (What happens when an older person’s named doctor isn’t around at weekends?) Furthermore, a problem that haunted Labour remains unsolved – namely, what to do about potential hospital closures.
But lucky people sometimes seem to make their luck, and so it is with Hunt. Rather than vanish behind that desk, he has emerged with a plan. He has done stints in hospitals and surgeries, experiencing for himself how the NHS ticks. Perhaps his background as a successful businessmen – one of the few in the Cabinet – helps to explain his purposefulness and clear thinking. He isn’t always popular with the Ministers who serve under him, but his ratings with Party members have climbed. He is emerging as one of the main architects of the Government’s programme of radical public service reform.