Executive Summary: The government's first 100 days

Look who’s back

Following the Conservatives shock outright election win on 8 May, Jeremy Hunt had to wait three days before being reappointed as health secretary by David Cameron – and endure rumours that eventual environment secretary Liz Truss could have replaced him.

Mr Hunt told HSJ last year that he wanted to be health secretary until 2017, claiming he “would be very happy if this is my life’s work”. He has been in the post since autumn 2012. HSJ editor Alastair McLellan applauded the PM’s decision.

There were both new and familiar faces at the Department of Health in the shape of ministers Alistair Burt, Ben Gummer and former CQC chair David Prior.

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#SevenDayServices

Mr Cameron’s first speech after returning to Downing Street focused on the government’s plans for a “seven day NHS”, underlining how much or a priority it would be. Mr Hunt had already made this clear in an interview with HSJ while on the campaign trail.

The health secretary also put seven day services at the heart of his first post-election speech. Billed as his “25 year vision” for the service, it’s better remembered for him squaring up to the British Medical Association over changes to doctors’ contracts, with the aim of turning seven day aspirations into reality. A Review Body on Doctors’ and Dentists’ Remuneration review published on the same day gave Mr Hunt confidence going into battle, and he’s unlikely to be deterred by angry doctors telling him #IminworkJeremy.

All about the money

The other big theme in the first 100 days has been combating overspending by NHS providers. Trusts’ net deficit is forecast to top £2bn this year, and the government has ordered a string of interventions to get it down.

The clampdown on agency spending, procurement targets stemming from the Carter review, the Care Quality Commission being told to rate efficiency and new outturn targets from Monitor heaped pressure on providers and indicated a shift in tone from the centre. Then the DH took steps to curb protests against next year’s pricing plans.

“The fingerprints of the Treasury are highly visible on the government’s health policy,” King’s Fund chief executive Chris Ham wrote on hsj.co.uk on Monday. One chief exec put it more succinctly: “Cash is king again.”

Forward view back-and-forth

The Conservatives made a firm commitment to back the NHS Five Year Forward View before the election, pledging a “minimum real terms increase in NHS funding of £8bn” by 2020.

There are still unanswered questions about where the £8bn will come from, let alone the £22bn efficiency savings the NHS has to make in exchange, but the forward view is kicking on.

The new care models project has got up and running through numerous vanguard sites, but George Osborne’s £200m cut to the public health budget has been seen as a blow for the associated prevention drive.

Who decides what’s safe?

One of the biggest talking points over the last 100 days has been the fate of work on guidance for safe nurse staffing levels. NHS England took the job off the National Institute for Health and Care Excellence in June, after which there was much debate about the rights and wrongs of the decision, and whether NICE should publish its latest guidance (it defiantly decided it would, then backtracked).

Hunt’s intervention during his “25 year vision” speech dictated that NHS Improvement - the new regulator to be formed out of Monitor and the NHS Trust Development Authority - will take forward the work; but NICE will review it.

Rose review – here at last

The long awaited review of NHS leadership by Lord Rose slinked out alongside the other elements of Mr Hunt’s “25 year” plan, calling for the NHS graduate scheme to grow tenfold and Health Education England to take over NHS Leadership Academy.

There was nothing as outlandish as the recommendation made in HSJ’s April Fool article earlier this year, which mooted £1m bonuses for managers. Perhaps this failed to receive Treasury approval.