Analysis: Decisions need to be taken before Hunt's honeymoon ends
The Department of Health is already consulting on its first “mandate” to the independent NHS Commissioning Board, and is due to publish a final version in October. Jeremy Hunt will have to decide how much he wants to change the content. Shifts could include a greater number of targets – something which his predecessor Andrew Lansley resisted – or a reduction in Mr Lansley’s pressure on the board to devolve power to clinical commissioning groups. There may also be a temptation to delay the mandate, but this could lead to a loss of momentum in setting up the new commissioning system.
Any shifts could send powerful signals to GP commissioners about whether their role and autonomy will continue to be robustly defended by the health secretary, as it has been by Mr Lansley.
Similarly Mr Hunt will have to decide how much he respects the independence of the board and how much he wants to make his own interventions in the running of the NHS, which could help boost his popularity.
Mr Hunt will have to shape his relationships with commissioning board chief executive Sir David Nicholson – the most powerful person in the NHS – and its chair Malcolm Grant.
Mr Hunt will, like his predecessor, be faced with an unprecedented squeeze on NHS finances for the remainder of the Parliament. He will likely be faced with the next comprehensive spending review settlement being as severe as the current one, which means he will be the man tasked with selling the public – and the NHS – several more years of austerity and efficiency challenges.
Whether the NHS can meet these challenges will depend to a large extent on the ability of the new commissioning system to redesign services and make care pathways more integrated. Thanks to Andrew Lansley’s reforms, this is one area that he will be forced to entrust to the commissioning board, but if it goes wrong and quality nosedives or health economies go bankrupt, he will take the flak.
Mr Hunt will have been in the job less than six weeks when Robert Francis QC’s report into Mid Staffordshire Foundation Trust lands on his desk on 15 October.
The inquiry’s examination of the regulatory and supervisory systems surrounding the failed trust over 139 days of hearings was forensic and it will inevitably be a challenge for anyone picking up the responsibility for it at this stage to fully grasp all the issues and interests involved.
However, Mr Francis’s report could potentially provide Mr Hunt with a timely excuse to show Sir David the door. There may welll be high profile public pressure from patient groups for him to do just that. Mr Hunt will face the challenge of juggling their demands for decisive action with an NHS that largely insists it has already learnt the lessons.
Mr Hunt will receive DH’s director of provider delivery Matthew Kershaw’s first report on South London Healthcare Trust, the only one yet placed in the failure regime, in late October.
But the deadline set by Mr Kershaw for receiving expressions of interest to run all or part of the trust is next week. This will mean Mr Hunt almost certainly has to consider whether he wants to expand private franchise management in the NHS in the first weeks of his tenure.
No one expects South London Healthcare Trust to be the last in the failure regime and Mr Hunt must decide whether to pursue this for Mid Yorkshire Hospitals Trust and Barking, Havering and Redbridge University Hospital Trust.
A decision is also due by October on whether George Eliot Hospital in Warwickshire can be allowed to pursue a private franchise management arrangement, similar to the existing arrangement at Hinchingbrooke Health Care Trust in Cambridgeshire.
Later this month a review into the NHS Pension Scheme is expected to recommend giving independent sector providers and workers access to the scheme, in a controversial move that could weaken the competitive advantage of NHS trusts.
Meanwhile, national negotiations are continuing with unions over alterations to the Agenda for Change pay framework to try to reduce the pay bill for NHS trusts – a key part of the Quality, Innovation, Productivity and Prevention challenge. Mr Hunt will come learn that the move of the South West pay consortium of 20 trusts to draw up its own solutions outside Agenda for Change is proving controversial, with unions claiming it undermines national negotiations.
Mr Hunt will also need to consider how the NHS responds to the Treasury drive into introducing regionalised pay into public services. The chancellor has expressed his support for the move but deputy prime minister Nick Clegg has voiced his opposition to local pay.