Hunt tries to keep it simple, but NHS England has other ideas

Jeremy Hunt’s exclusive interview with HSJ was notable for his observation of a principle that has informed good politicians throughout the ages: KISS − “keep it simple, stupid”.

‘A desire to focus on the big picture should not be taken as lack of interest in the detail of NHS performance’

This is not because Mr Hunt is frightened or confused by policy detail; most people who work closely with him comment on his sharpness. The health secretary is instead guided by a well judged estimation of how politicians can best make an impact. Take one idea − with broad public appeal − and repeat the message. In 2013 Mr Hunt marched under the banner of improving care for frail older people; in 2014 he has moved on to the related issue of continuity of care.

The quality of care for the service’s most frequent users will be his theme until the election. Expect him as part of that to continue the “uncomfortable process” of dealing with “poor care that grabs the headlines and shakes people’s confidence”.

Mr Hunt expressed his pride in the NHS and said the best way to improve staff morale was to be unresting in rooting out the poor care that made him “angry”. While welcoming that the NHS does appear to be finally crossing the Rubicon over care quality transparency, it is also regrettable that the next 14 months will be especially bruising for those who work in the NHS and may yet leave a damaging legacy.

Not a micromanager

A desire to focus on the big picture should not be taken as lack of interest in the detail of NHS performance. Mr Hunt was insistent he is not micromanaging the NHS and repeatedly said it was up to the professions and employers how best to deliver his call for “named consultants”.

‘Hunt’s agenda is not the only game in town. Work by NHS England is identifying the radical level of change needed to keep the NHS afloat’

But there is more than one way to keep the service focused on the issues that concern you. Mr Hunt continues to send questions about accident and emergency performance coursing through the system; but he remains content to let the service go its own way on meeting the 18-week elective waiting time target.

Mr Hunt also appears to have little interest in competition as a driving force. As clinical commissioning groups roll over community services contracts to their incumbent − usually NHS − providers, he will not be hammering on Monitor’s door telling them to scrutinise the decisions.

Expect a firm line with unions on pay rises − based on research that higher salaries result in fewer staff and that the numbers game over rises or falls in clinical staff is the one he wants to win. A less confrontational line will be taken with the medical professions over the changes in culture and employment conditions needed to deliver the developments such as seven-day working or improved GP access that underpin improved continuity.

Hunt’s track record

However, Mr Hunt’s agenda is not the only game in town. Work by NHS England is identifying the radical level of change needed to keep the NHS afloat on current levels of spending growth.

The conclusions suggest the need for a dramatic concentration of specialist services, a significant reconfiguration in emergency care and the need for much greater scale in primary care.

Mr Hunt claims, with some reason, he has a good track record in backing controversial reconfigurations supported by good evidence. But he is less willing to engage directly with the scale of change at a system level being identified by NHS England, or indeed in the Royal College of Physicians’ future hospital commission report from which his “whole stay doctor” idea was plucked.

As a result Mr Hunt is open to charges that he is leading the public to believe NHS care can be transformed without the probability that significant change to the organisations and teams delivering it may be necessary − and not within half a dozen health economies, but across the whole country.