New secretary of state faces a bulging in-tray
Two main explanations have been given for why Jeremy Hunt has been given the top job at health.
Either he is there because of his ability to communicate a clear and simple message to the public, or because he is admired for his implementation ability (with the Olympics cited as an example). In truth, he is probably there because he is simply very different from Andrew Lansley.
Tired of the controversies over the NHS, and expecting the stormy waters of reform to be largely behind them, Downing Street is hoping that Jeremy Hunt will be the man to keep health quiet. However, this hope is misguided. The reforms were difficult for the public to relate to. The decisions which will need to follow are not.
David Cameron must be confident that Lord Leveson will spare Hunt from criticism over BSkyB, but journalists may not be so forgiving. Having previously called for his resignation, expect some papers to leap on any misstep now he has been promoted. This is important given that the government’s political difficulties on health are far from over. Simply being different from Andrew Lansley will not be enough for Jeremy Hunt to avoid them and in fact Hunt’s recent past will simply add to the focus.
If Lansley was an encyclopaedia of the NHS, then Hunt is an unwritten book. His main experience of health was helping lead the successful campaign to ‘save’ his local hospital - the Royal Surrey. Beyond that, he has had little opportunity or inclination to immerse himself in the subject. Yesterday’s discussion over his apparent support for homeopathy is not a sign of a great interest in the issue, just an indication of how little engagement he has had with most of the health agenda.
Jeremy Hunt may be new to the health scene, but two of the other leading protagonists are more familiar. Norman Lamb comes to the department he shadowed in opposition and an issue – in social care – which he will feel is unfinished business. He comes with a reputation for winning the Liberal Democrat grassroots over to controversial policies, such as Royal Mail privatisation. No doubt David Cameron and Nick Clegg will be hoping he can do the same with NHS reform.
Andy Burnham will be as familiar to Jeremy Hunt as he is to the health world, with the two having opposed each other at Culture, Media and Sport before the election. During this time they actually developed a friendly relationship. Whether this sustains remains to be seen.
The new secretary of state’s inexperience at health will mean he approaches the issue with more of an open mind. This may come as a relief to some, who were perhaps tired of the iron certainty of his predecessor. There will, however, also be a cost to this: Jeremy Hunt will quickly feel buffeted by the competing priorities and demands of Number 10 and the NHS Commissioning Board. How he handles this tension will help determine what kind of a secretary of state he is. Expect the first test of this to be a debate over how prescriptive the mandate should be (Downing Street will want it be very detailed, the board for it to be somewhat different).
Besides this, the in-tray will include managing the South London Healthcare Trust administration, where he will find that although he is removed from the legal process, this will not protect him from the political fallout. If services have to be removed from successful nearby providers and placed in a failing organisation in order to find something to fill expensive PFI buildings, then expect this to get very messy indeed. Of course South London will only be the start. Expect similar problems at other hospitals, including in Yorkshire and Cumbria.
On top of this, he will need to lead the government’s response to the Francis Inquiry and will do so knowing that he is unlikely to be able to offer legislation as part of the response (the Health and Social Care Act was quite enough for most people across the coalition). There is also likely to be more pressing issues at Mid Staffs: the trust is struggling to recruit and is haemorrhaging money. On both quality and financial grounds, this situation cannot go on.
The coming year will also require action to resolve the fiendishly complex value-based pricing policy and to seek to find a longer term solution to social care funding. Liberating the NHS did not clear the secretary of state’s to do list.
Mike Birtwistle is the managing director of MHP Health Mandate