Hunt battles his 'inner Stalin' to deliver the NHS’s 'reformation moment'

In spring next year, barring a reshuffle, Jeremy Hunt will become the longest serving health secretary. Should he stay in post another year, only Norman Fowler and Aneurin Bevan will have had longer terms as the cabinet member with responsibility for the country’s health services.

‘It is only natural given that Mr Hunt’s mind is turning to the legacy he will leave’

If Mr Hunt is still at Richmond House in 2018 he will celebrate the NHS’s 70^th anniversary unchallenged in his ministerial longevity.

Given this, it is only natural given that Mr Hunt’s mind is turning to his legacy.

‘True party of the NHS’

The suggestion of ideas contained in this morning’s wide-ranging speech constitute a “25 year plan” for the NHS is a little over-blown; it is effectively a roundup of overdue policy announcements which needed to be made before the summer recess and some kite flying of new ideas.

That does not mean, however, that it should not be taken very seriously. The health secretary is convinced he can persuade voters that the Conservatives, which has stewarded the service longer than Labour, are “the true party of the NHS”.

He wants to bring this about by redefining the relationship between the public and the service. He wants the NHS to travel a similar journey as the state education sector, which - for better or worse - is now viewed very differently by the public, politicians and media than it was 20 years ago.

Just as David Cameron and George Osborne have often been described as “the heir to Blair”, so Mr Hunt’s speech channels the spirit of a Labour health secretary whose term he is on course to exceed.

‘The question that looms large is how we will be able to resist blunt intervention’

It was Alan Milburn who referred to the NHS as “a secret society” back in 2001 and began the push for greater transparency. He also took a hard line with the British Medical Association at the beginning of the 2002 consultant contract negotiations. 

Mr Milburn left frontline politics before either of the battles were concluded and a strong sense of completing unfinished business emanates from today’s speech by the health secretary.

The section of the speech likely to get most attention from HSJ readers is Mr Hunt’s commitment to driving the service through a focus on “improvement” rather than “top-down targets”.

It would be easy to scoff at this, but not necessarily wise. Mr Hunt does genuinely favour the use of a wide suite of metrics to drive forward both the performance of organisations and individuals and will push this approach hard. The question that looms large in the minds of those working alongside him is how he will be able to resist blunter intervention - what Mr Hunt refers to as every health secretary’s “inner Stalin” - when the NHS’s finances are in such a perilous situation.

There was much nervousness from the Treasury as this speech was being written – particularly over the new powers and responsibilities being given to NHS Improvement, the new name given to the effectively merged Monitor/NHS Trust Development Authority. Understandably they want a resolute focus on the bottom line and are not convinced the NHS is taking enough responsibility for meeting the financial challenge.

As one very senior source commented to HSJ, “the deal on the £8bn isn’t done yet”, adding that the exact terms of how the money might be allocated depended very much on the service’s financial performance and especially the managing the acute sector deficit without the resort to bailouts.

His ‘reformation moment’

As NHS Improvement’s chair Ed Smith begins his search for the organisation’s chief executive, possible candidates will be attempting to judge how much weight is really being attached to the new moniker.

Those leading foundation trusts will also study the new direction of travel and wonder what, if anything, their often hard won status means in this new world when all are held equal before a growing raft of metrics.

These metrics, as Mr Hunt acknowledges, will soon be applied to the performance of clinical commissioning groups. Earlier this month HSJ commented these metrics would be the vehicle that would ease the NHS towards a more mixed model of provision and, indeed, commissioning. Mr Hunt confirms the NHS should be agnostic about exactly how services are constituted.

‘There is no doubt that Mr Hunt is determined to make his mark’

In his first three years as health secretary Mr Hunt has spoken relatively little about patient choice. This final passage of his speech is therefore especially interesting. The work NHS England will undertake on choice in maternity, end of life and long term conditions care will give new life to the often ignored chapter two of the NHS Five Year Forward View, which focuses on patient empowerment.

At present, for example, there are only 3,000 personal health budgets, compared to over 600,000 in social care. Expect that gap to close significantly.

The focus on digital health services is also marks a determination to finally bring the information revolution to the NHS.

Mr Hunt believes his proposals constitute a “reformation moment” for the service. Only time will tell if that claim can be justified. There is no doubt, however, he is determined to make his mark.