Cowper’s Cut: It’s raining NHS spending rhetoric: Hallelujah!

One delight of observing current British politics is watching people who aren’t obviously natural weathermakers go about the business of trying to make the political weather.

Making the political weather is a rare trick. To shape the political and public landscape is to dominate and direct lives and cultures, just as the physical weather does in differentiating Sweden from Senegal and Saint-Tropez from Saint Petersburg.

The health and social care secretary Jeremy Hunt is not an obviously natural political weathermaker: he is also a man whom his opponents have found it easy to underestimate.

It is foolish to underestimate any opponent, and Mr Hunt has made easy work of seeing off John Healey, Andy Burnham and Diane Abbott without breaking a sweat.

The Lansley Reforms did not take place

Mr Hunt came into a job which Lord Lansley had sculpted into the political equivalent of a semi-detached cathedral, designed to fit into a landscape shaped by the political weather of choice, clinical commissioning and competition.

The striking thing about Lord Lansley’s reforms is that while they happened in a structural sense (150 odd commissioning bureaucracies were duly replaced by 220 odd differently named commissioning  bureaucracies), in the meteorological sense, they didn’t happen even slightly. 

The real NHS reforms of the 2010s have been driven almost solely by central edicts and tools: pay freezes and tariff cuts; agency caps; encouragements to merge; ignoring national waiting standards. Choice and competition have not been at the races, while clinical commissioning turned out to be the biggest health policy unicorn of the 21st century.

Secretary of state for life

Mr Hunt made what he could of the remainder of the secretary of state for health and social care job, which was to reinvent himself as the national director for patient safety and Monday morning provider performance phone calls. Somebody has to do this, I suppose.

In doing so, Mr Hunt is on his way to pass Norman Fowler in June to become the longest serving health minister in British political history. Indeed, when the prime minister tried to move Mr Hunt last year, he not only kept his job but added the social care portfolio.

We (still) need to do better on social care

This week, Mr Hunt gave a speech telling us that “we need to do better on social care”. That sentiment, and indeed the speech’s slender content, could have been given by any secretary of state for health and social care in the past 20 years.

Two decades after The Royal Commission On Long-Term Care, and with the Dilnot and Barker Commissions, it remains politically possible for the responsible Cabinet minister to stand up and tell us with a straight face that “we need to do better on social care”. (Stop press: Pope still Catholic; bears still defecate in woods.)

The issue for social care is that to provide a universal service for an ageing and comorbid population without a means test will be expensive.

Yet we have seen the aspirant political weathermakers make the heavens open with discussion of increasing NHS funding, as I touched on in recent columns.

Mr Hunt joined in with the NHS Rhetorical Spending Review on ITV’s Peston On Sunday show, reiterating his position that the NHS will need more funding, which he thinks should be given in a 10-year funding settlement. 

He stressed that the source of the new money would have to be from either economic growth or tax rises. Interestingly, given the political jungle drumbeat heralding a rhetorical boost to NHS funding that my recent columns have tracked, Mr Hunt was keen to ward off any hint of a premature congratulation about a boost arriving on the NHS’s 70th birthday in July.

That was an interesting note for Mr Hunt to strike. The Sun King Of Skipton House, NHS Commissioning Board boss Simon Stevens has dropped hints of varying levels of subtlety, but as I have frequently observed, Mr Stevens does not (yet) have statutory tax raising powers.

Rhetorical outriders on the storm

I think that an interesting tactic is happening here. Whatever the driver behind the scenes (and there are always scenes behind the scenes), I suggest that Mr Hunt is doing a self consciously public show and tell to the Whitehall machine (the main intended audience of the Sunday politics TV shows).

What is Mr Hunt’s message to the machine? “Oh, I don’t think we should get ahead of ourselves with talking about GIVING THE NHS A DESPERATELY-NEEDED AND POLITICALLY POPULAR FUNDING BOOST ON ITS 70TH BIRTHDAY IN JULY.”

“Oh, sorry, did I just mention GIVING THE NHS A DESPERATELY-NEEDED AND POLITICALLY POPULAR FUNDING BOOST ON ITS 70TH BIRTHDAY IN JULY.”

“I did? Really? I said that? Out loud? In the real world?”

“Ah. That’s the sort of loose talk that could put ideas in people’s minds. Don’t mind me.”