Hunt: I'm open to NHS or private sector solutions
Health secretary Jeremy Hunt has told HSJ it is “not my job to hold a candle” for either NHS or private sector providers when deciding what is best for patients.
However, as part of his first in-depth interview on the government’s health policies, he claimed the listed company Circle’s management of Hinchingbrooke Health Care Trust had shown the independent sector was “able to provide the levels of clinical treatment and care” equal to that of the NHS.
Mr Hunt also:
- pledged to respect the “operational independence” of the NHS, despite holding regular meetings with system leaders on a wide range of performance issues
- admitted that he expected to have to deal with “every controversial” hospital reconfiguration
- said the pooling of health and social care budgets would be “a big part of the direction of travel”.
The health secretary’s role
The health secretary rejected the suggestion that his regular meetings with system leaders amounted to “performance management”.
Mr Hunt claimed that in giving the NHS “operational independence” the government had granted the service “what the police and schools have had for years.” However, this did not mean “any less political accountability”
He told HSJ: “I know the public care about the 18 week waiting list target, four hour A&E waits and mixed sex wards - and one of things the public will judge me on is my performance against those measures. So I want to know what’s happening.”
“As health secretary I have right to ask questions if I think something is going wrong, and offer views,” he continued. “But what I don’t have the right to do – and I think it’s right that I don’t – is direct what happens on the ground.”
He claimed he would “respect the full operational independence” of the NHS Commissioning Board”, adding that “the difference between the old world and the new is that if there was a solution that appealed to me – but they didn’t want to do it – they could say no. It’s a much healthier relationship.”
Mr Hunt said: “I’m looking at the NHS as a whole, recognising that this is a system with a lot of pressures. I’m making sure I understand where the pressures are and that the system is responding in the way that it needs to deal with those pressures. I think the public would want to know they have a secretary of state who is completely on top of all the pressures in the system and knows what’s happening.”
However, he added: “I’m not, for example, taking the waiting list targets and then getting a list of the trusts that are underperforming and getting in touch with the chief executives of those hospitals and saying ‘what’s going wrong here?’.”
Asked what kind of performance issues he was discussing at present, he said: “Norovirus, winter flu jabs – how we’re going to cope with winter pressures, those are the kind of things which, in the run up to winter, I think it is my job to know about it.”
Asked if he had discussed A&E waits in the wake of the Care Quality Commission report which showed public concern about longer waiting times, he said: “As it happens we haven’t had a lot of discussions about it, because the commissioning board is confident that we’re meeting our targets on that.”
Despite standing back from most frontline decisions, Mr Hunt admitted that “every controversial” hospital reconfiguration “will end up with me”.
Asked how he would deal with this, he said: “I get independent advice on the best way forward – and that will be the primary thing that guides me - but I will have to decide in the end if I agree with it.”
The private sector
Mr Hunt also claimed it was not his “job to hold a candle for the independent sector or the traditional NHS sector” when deciding what kind of solution would be best for the patients of a struggling healthcare provider.
Asked whether there was enough appetite from private healthcare providers to make the Hinchingbrooke model a substantive part of the solution to those trusts struggling to make foundation status, Mr Hunt declared: “That’s not a matter for me. What I do as health secretary is I look at the whole situation, I look at the independent advice I get. If there’s an independent sector solution that can work well – then, obviously, I will be open to that. If there’s traditional NHS institution-led approach that can work – then I’ll be open to that.”
He continued: “The impression I get is that the independent sector are more interested in getting involved in some situations than others. I don’t say there’s any pattern there - it’s just that some problem areas get presented to you and there is apparently independent sector interest and other areas get presented to you and there isn’t”.
Mr Hunt said the way Circle has tackled the management franchise of Hinchingbrooke Health Care Trust had surprised many.
“What’s interesting about Hinchingbrooke is that when [the franchise] started a year ago the whole debate was whether an independent sector provider was going to be able to provide the levels of clinical treatment and care that an NHS establishment would and actually Circle has proved that they can. So now the question is – and it is completely not what people expected – why haven’t they reduced the deficit more quickly? Everyone expected a private sector provider to crunch the deficit more quickly than anything else.”
Asked whether he would sanction a similar private sector franchise model for George Eliot Trust, Mr Hunt said: “I’m waiting to receive proposals from my team as to the way forward.”
Turning to the use of mergers to resolve the problems faced by struggling providers, he said: “If you look at the business world, the evidence is very clear that mergers are not always a panacea for troubled organisations and that very often the merged organisations is much less effective than envisaged at the time of a merger, so you do have to be careful.
“There are cost savings that can be made in terms of management overheads, sometimes there are efficiencies in terms of services, but where there are deep rooted cultural problems, I think you have to be very careful in saying that a merger is going to be a panacea. You need to understand what those problems are and tackle them regardless of whether the organisation becomes part of a larger organisation.”
Mr Hunt endorsed the proposals put forward by Liberal Democrat care services minister Norman Lamb to stage a series of large scale integrated care “experiments”.
He said: “The central challenge here is that the tariff system works very well for people who have curable illnesses, someone who needs a new hip, a new knee or a cataract operation. The NHS is really geared towards the kind of situation where: person has a problem, problem is solved, person goes home.
“It’s much less good at dealing with people who have a long term condition, that need long term support – that particularly applies to the frail elderly and the structure we have at the moment does not really incentivise a person-centred approach to treatment. There’s a lot of work going on by the commissioning board at the moment to look at how those structures need to be improved in order to recognise the need to give a more integrated service to people with long term conditions.”
Facilitating these changes would mean greater sharing of funding across health and social boundaries. “That’s going to be a very big part of the direction of travel,” he said.
“How much we need new legislation for this, or not, is something we will be exploring. But pooling of budgets [and] a really close working relationship is going to be very important.”