As he perhaps starts to wind down in the role, the health secretary should go big on patient safety and keep quiet on that disputed contract

Jeremy Hunt has never been afraid to argue his case. He impressed many in his early days as health secretary by his ability to speak at length – usually without notes – to a wide range of audiences.

Mr Hunt again demonstrated that admirable willingness to engage when he accepted HSJ’s invitation to join a conversation with three healthcare leaders about the government’s health policy and his leadership of the NHS.

What the conversation revealed, however, was often less encouraging.

It is now clear that – like Sherlock Holmes and Moriarty at the Reichenbach Falls – the health secretary and the British Medical Association’s junior doctors’ committee are locked in deadly embrace – each driving the other to more destructive behaviour.

Asked if anything could persuade him not to impose the new junior doctor’s contract, Mr Hunt declared “the matter is closed” (it is, very obviously, not). He continued what now feels like the deliberately provocative narrative of the past few months that the dispute is all the fault of the intransigent BMA misleading their naïve members, while digging himself ever deeper with the entirely unnecessary and ludicrous claim that “he is more in tune with doctors”.

Undermining public trust

In turn, the JDC cannot turn the other cheek and soon take up the spade themselves. They attempt to conflate the dispute with every other NHS issue going in an effort to hide the apparent weaknesses in their case; they ignore their own legal advice [the surest sign of negotiators who are letting their heart rule their head]; and in declaring an all-out strike they take the one step which they must know will begin to undermine public trust.

For the medical profession the reckoning will come in years ahead as doctors become increasingly viewed as just another self-interested lobby group.

For Mr Hunt the dispute is likely to spell the end of his time as health secretary during the months following the EU referendum.

This change would now be welcomed by most healthcare leaders, who in contrast would have favoured continuity a year ago. They know that no trust chief executive who has lost the confidence of his doctors can achieve anything worthwhile regardless of the rightness of their plans or the energy with which they pursue them.

Hunt equally understands that the hard line he is taking will do him no harm when the cabinet is reconstituted

Mr Hunt says that confidence would appear once the dispute had been settled. That is a very bold claim and the NHS cannot afford to wait to find out if he is right.

In any case, reading between the lines, it is possible to see the health secretary is also eager for the sweet release of a reshuffle. He is a clever man – he knows that his ability to influence change has been severely compromised by the dispute. He equally understands that the hard line he is taking will do him no harm when the cabinet is reconstituted.

Number 10 has underlined its commitment to Mr Hunt and the health secretary says he is determined to carry on if the PM wants him to. However, no less than five times during the hour long conversation, the health secretary spoke of what he wanted to be remembered for. When a politician starts to focus on his legacy then you can be sure he knows the end is near.

Already plans are being made to limit the damage the health secretary can do. The forthcoming GP rescue package, for example, is likely to be announced by NHS England chief executive Simon Stevens - not Mr Hunt.

Incoherent narrative

The health secretary is now left to pursue his passion for safety, something history is likely to acknowledge him for. However, as Health Foundation chief executive Dr Jennifer Dixon pointed out during the HSJ meeting, Mr Hunt’s eagerness in his last few months to pursue myriad initiatives is producing a sometimes incoherent narrative. It is also leading to the sloppiness of execution so brilliantly exposed by fellow panellist Claire Murdoch at the start of the meeting.

This challenge gives Mr Hunt a useful and practical to do list for his remaining time in post. He must make sure the proposed changes to how quality, safety and efficiency in the NHS is monitored, measured, regulated, inspected and spread take place within a coherent and easily understood framework.

His shift in mindset from an emphasis on driving change through inspection to achieving improvement through cultural change is a genuine one, but it is not sufficiently understood by those who will have to make it work. He could also be usefully active on insisting that a much clearer plan on implementing the Carter review is put in place before the summer.

We suggest he tries to say as little as possible about junior doctors – his successor will thank him.

Readers can make their own judgements of Mr Hunt’s views by watching a video of the three sections of the conversation on safety and quality; funding and efficiency and workforce and morale. They can also view HSJ’s leadership panel reflecting on the conversation.