David Cameron suffers from a gap in imagination which fails his vision for the NHS

Let’s park Jeremy Hunt for a moment, he’s been getting more flak than even he deserves.

“Hunt’s not the cold hearted monster I keep hearing about from the junior doctors, is he?”asks a former Thatcher Cabinet minister. No, he’s not. David Cameron is the one who really puzzles me.

The other day the prime minister put his personal seal of approval on the report by the mental heath taskforce, chaired by Mind’s Paul Farmer. It’s the report that prompted Cameron to promise an extra billion a year for this “chronically under-funded” service by 2020 and better community outreach to those struggling with debilitating problems.

Excellent. There can be very few of us without experience via family or friends of mental ill health that hobbles lives and worse.

Suicides, especially among young men, are now pushing 5,000 a year and a friend told me recently of a self-harming young woman who had performed a primitive form of FGM on herself. Assorted pressures on the young are intense and I sense that many lack the resilience of their more stoical elders.

Crises and headlines

But where exactly will the money come from, Dave? Hunt and his minder, Simon Stevens, talk about parity of esteem with physical ailments and the need for a seven-day mental health service which addresses neglected areas like the needs of ethnic minorities.

Cameron signals that Iain Duncan Smith’s Department of Work and Pensions is soon to publish a white paper that requires Job Centre staff to address Farmer’s point about anxious and depressed people getting back into work.

That said, there’s something more than routine going on with this UK government. It is a disconnect between words and actions which is wider than voters have come to expect

None of this is cheap though, although it will save money in the long term, much like all-purpose troubleshooter Lord Carter of Coles’s latest report on NHS productivity. Private care entrepreneur Carter produced ideas that could save £5bn a year by 2020 if implemented by NHS laggards. Unfortunately governments rarely inhabit the long term for long.

Entering office with good intentions not to be driven by crises and headlines, they are quickly worn down by both. In our connected 24/7 world a plunging Shanghai stock exchange, the religious quilt that is Syria or the politics of Venezuela (watch Venezuela) can impact on the public finances to derail Carterish plans almost as easily as a severe winter.

Oxbridge elitism

The NHS has not had a severe winter in 2015-16, but is being told that A&E can now expect a four season crisis. Thank you, Nuffield Trust. NHS productivity is also falling (thanks, Health Foundation) but why? Pressure? Poor morale? The budget squeeze?

As with HSJ’s scoop about our unexpected rising death, the temptation to politicise the explanation should be resisted. Evidence please.

That said, there’s something more than routine going on with this UK government. It is a disconnect between words and actions which is wider than voters have come to expect.

Two weeks before his “we haven’t done enough” embrace of mental health, Cameron spoke out against the elitism of Oxbridge in not taking enough poor or ethnic minority students. As with a similar foray by then-chancellor Gordon Brown in 1999 it quickly came unstuck: you can’t give places to kids who don’t apply. Brown’s Oxford-rejected “victim,” Laura Spence, went to Harvard instead and later graduated in medicine at Cambridge (2008). Does that make her a striking junior doc? Or did she leave for Sydney? Good question.

Undeterred, Eton-and-Oxford’s Mr Cameron has since turned his attention to prison reforms: violence and drug-taking “should shame us all,” he said when outlining plans to devolve budgets and greater autonomy to prison governors. Bless my soul, it sounds like NHS reform. Will they be calling them Prisons Trusts soon? They just may because “name and shame” league tables on reoffending and literacy rates are also part of the package.

Overwhelmed by events

The stress is now on discipline and outcomes whereas as recently as 2007 it was on building more and bigger prisons (PFI, anyone?),  according to a report by, yes, Lord Carter of Coles.

Devolving authority is often a good thing, less so when greater duties on systems and staff are simultaneously being imposed from the centre. Less so too if the suspicion lurks that blame is also to be devolved when things go wrong, as they do in cash-strapped times with growing waiting lists.

Cameron is not stupid or cynical, but there is a gap in his experience or imagination. It tempts him to steer the Tories back towards the fabled centre ground vacated by Corbynite Labour without willing the means to make his touchy-feely policy pronouncements real to wary voters.

In his NHS-friendly interview with the Guardian he conceded the need for much more money alongside reform. That’s progress, but Hunt (and Cameron) may soon be gone, overwhelmed by events beyond their control. A bit like A&E on Friday nights really.

Michael White writes about politics for the Guardian

Has Jeremy Hunt been health secretary for too long?