Hunt must show he is in it for the long haul to sustain the NHS

Rabbits were successfully pulled from hats at this week’s Conservative party conference, leaving ministers bathed in the glow of appreciative newspaper front pages. The cancer drugs fund is to be extended for another two years, offering hope for patients who would otherwise have none, while an apparent solution is in sight for patients who struggle to access primary care in the form of a pilot to extend surgery opening hours.

‘The NHS needs controversy. It needs a ministerial team prepared to break bad news, as well as good’

The first line of the Conservative press release trumpeting the latter policy said much about the target audience: “Hardworking people will be able to see their GP seven days a week and out of office hours under new proposals set out by the prime minister…”

While any bid to ensure the health service responds to patient demand is to be applauded, it is undeniable that the policy has been targeted to win over the electoral demographic that all parties are currently seeking to attract.

An election is on the horizon and parties have been clamouring to offer meat and drink to their target audience. Free school meals, frozen energy prices and the marriage tax allowance all offer financial relief to the “squeezed middle”. However, in health there is little evidence that policies designed in the run-up to an election are going to help ensure sustainable services in the long run.

Limits of independence

The cancer drugs fund serves as a sticking plaster until a long term solution is devised to ensure appropriate and cost effective access to drugs. Seven-day GP working is welcome but we are yet to discover how the extension of the pilot nationally can be funded. The move must also form part of the whole NHS working 24 hours, seven days a week − something that requires the reorganisation of many services into units large enough to enable consultant cover at all times.

Decisions are being put off in many areas that carry less appeal to the floating voter. As NHS England chief executive Sir David Nicholson complained in June, the reconfiguration of hospitals is one such area.

‘Being brave enough to take decisions that ensure the NHS survives would be the greatest long term boost for Hunt’s CV’

Health minister Dan Poulter this week sat on the fence when HSJ asked him if there should be a rewrite of the competition rules preventing the merger of Royal Bournemouth and Christchurch Hospitals and Poole Hospital foundation trusts. Jeremy Hunt also stopped short of addressing these controversial issues in his conference speech.

But the NHS needs controversy. It needs a ministerial team prepared to break bad news, as well as good. While Andrew Lansley’s vision of an independent NHS England foresaw ministers staying out of the day to day running of the service, the government’s response to the Safe and Sustainable reconfiguration of children’s heart surgery and Mr Hunt’s announcement that he would personally report each quarter on the progress of “failing” hospitals show the limits of this independence.

Make tough decisions

Failure to tackle the NHS’s financial problems is in danger of making it unviable. If ministers perceive little appetite among voters for more of their earnings to be taxed in order to fill the NHS’s looming £30bn financial black hole then they must be prepared to take radical action to make the service sustainable.

To have a true democratic process, politicians need to debate the nation’s trickiest dilemmas. The toughest issues inevitably lead to upset and some of the necessary changes will be unpalatable to many. However, more unpalatable is a deceit in which nasty surprises are withheld until after 7 May 2015, or services degrade in an impasse caused by difficult decisions being put on hold.

Rightly or wrongly, Jeremy Hunt is perceived by many as an ambitious man who sees health as a stepping stone to one of the four great offices of state. To prove the doubters wrong, he can show he is in it for the long haul, taking decisions that will sustain the NHS beyond 2015. Being brave enough to take decisions that ensure the NHS survives would be the greatest long term boost for his CV.