Andrew Lansley once told HSJ that he wished to be “the last health secretary anyone knew about”.
In other words, he wanted to be so successful in devolving power to “the front line” that the identity of the man or woman running the Department of Health would be of only passing interest.
In contrast, Stephen Dorrell, health secretary in the mid-1990s, once admitted to HSJ he neither “checked nor cared” what the contemporary legislation said about his responsibilities. He was the health secretary and in the minds of the electorate, his prime minister and the opposition, the buck stopped with him.
We shall soon learn which of these poles Jeremy Hunt orientates towards, but HSJ would be unsurprised if the new health secretary was more of a Dorrell than a Lansley.
This is not because Mr Hunt will want to manage the NHS from his desk, or that he is not committed to the plans of his predecessor, but because he will want people to know that he can and will intervene when necessary.
The NHS has now firmly entered the delivery phase of the reforms and the name of the game is both assurance and reassurance: assurance that each part of the new system is doing what it is intended to do and reassurance that quality does not suffer and will, hopefully, improve.
The need to both assure and reassure lies behind the decision to define specialist commissioning in the widest possible terms, handing the NHS Commissioning Board a direct budget of £12bn. This is intended to ensure clinical commissioning groups will not have to struggle at the most complicated end of the commissioning spectrum, while reassuring patient groups and Number 10 that “postcode lotteries” in high profile diseases like cancer can be avoided.
Witness also the relatively cautious proposals for the break-up of South London Healthcare Trust, the overdue confirmation of David Bennett as Monitor chief executive, the latest tightening of the CCG authorisation scheme, the go-ahead for next year’s 1 per cent pay rise and the likely deal on a renegotiated Agenda for Change. Everywhere, pragmatism is ruling the roost.
Even the potentially inflammatory move to push forward on changes to GP contracts indicates an administration worrying less about GP support for the reforms and more about creating momentum for change which can be realised by 2015.
‘The need to both assure and reassure lies behind the decision to hand the commissioning board a £12bn budget’
Mr Hunt is likely to favour an approach which strikes a balance between Andrew Lansley’s policies and the realpolitik of the next two and half years of the coalition’s administration.
This strategy may be well illustrated in the contrasting approaches to the mandate givento the commissioning board and the scrutiny of hospital reconfigurations.
The mandate is likely to be a slimmer document than the one out for consultation. The government will expect and be comfortable with the row this causes over the lack of targets for certain specific conditions. Local decision-making is key, it will trumpet.
But when it comes to reconfiguration do not be surprised to see the government acts as if every major decision will eventually turn up on Mr Hunt’s desk. Yes, they will hope debates between local clinicians will remove much of the heat from these decisions, but they will not always be content to take local choices at face value.
Mr Hunt’s decision last week to refer the long-running review of children’s heart surgery services to the Independent Reconfiguration Panel is the sign of a man who wants to check and double check that he is on safe ground.