the hsj interview: Philip Hunt

Published: 17/04/2003, Volume II3, No. 5851 Page 20 21

Since resigning in protest at the prospect of war on Iraq, Lord Hunt has been free to speak out on the progress of health reform. Just do not expect him to be disloyal about Labour's broad ambitions Ifone imagines the NHS reform programme as a crocodile of schoolchildren dawdling in a museum, then Lord Hunt of Kings Heath, junior health minister until last month, was surely the brisk school teacher perpetually chivvying the stragglers at the back.

And a month since his shock resignation from the government in protest at the war, Lord Hunt remains largely in character.

'Those people who say that the pace is too fast just do not get the plot, really.And the plot quite simply is that we have got to deliver.

'We will never ever get another chance at this huge increase in resources, with such a clear map of where we are going - and we just have got to deliver it.'

So far, so on-message. But the people's peer is visibly adjusting to his new identity as an ex-minister on the backbenches.He veers from soundbites lifted straight from the government brief ('This is our last chance to build a truly first-class service') to frank asides about where the obstacles to NHS reform really lie ('it is absolutely ludicrous that we had to intervene...in operational management we are weak').

What marks both is his impatience; a relentlessly perky insistence that the critics carping from inside and outside the NHS should stop knocking and just get on with a programme that he broadly supports. Spit spot.

'The whole history of the NHS has been one of people whinging about the government and what the government is doing to it and I think we need to get a much more mature relationship between the service and government and Parliament.'

Ahem. Wasn't Lord Hunt one of the professional 'whingers' himself in terms of representing management's interests against reform overload during almost 20 years at the National Association of Health Authorities and its successor bodies?

Lord Hunt laughs. 'It is interesting because actually I do have some sense of guilt that at the association we often complained that the government was giving the health service too much to do.'

But he also recalls that when the government encouraged new broad policies without spelling out the details, allowing local freedom, plenty of members made the case for more explicit guidance. Either way, whingeing is off his agenda. Back, then, to the creation of a mature relationship between the service and the centre.

'I think foundation trusts are one of the ways in which [health secretary] Alan [Milburn] is seeking to do that. We want the NHS to grow up and take control of its own destiny.'

Ah, foundations: at the centre of a swelling rebellion which currently looks set to provoke a bigger backbench revolt than the Iraq war. At the last count, 130 MPs had signed a Commons motion rejecting the plans.

Lord Hunt says it was his experience within government that sparked his interest in the concept, which he believes has been widely misunderstood. As far as he is concerned, the story is not about freedom - it is far more about embedding local democratic control. 'By making them locally accountable they will have more space and freedom to do what they want to do.'

But politically the row over foundations has focused on increased borrowing limits and other financial freedoms.

And some chief executives of three-star trusts who found this attractive are less enamoured by the idea of increased accountability.

More fools them, as far as a just slightly impatient Lord Hunt is concerned. 'I really do think that some managers misread what it was all about. They got ever so excited about financial freedoms and That is one aspect, but It is a minor aspect compared to what it really is about - which is community governance.'

In which case, wasn't the government guilty of mis-selling the idea? 'I do not think it was. I remember talking to chief executives of three-star trusts about governance issues and I think it has always been stressed that this was very much about switch of accountability to local communities.But in the ether there was some fixation over financial freedoms... That is not what It is all about.'

The extent of opposition has left him 'puzzled', and he believes concerns about two-tierism should have been eased by the government's stated aim that every trust will be a foundation trust.

But he says he sees no sign of the government losing its nerve on the policy - and after a brief 'vow of silence' in the Lords to provide some clear blue water between his life in government and outside, he is looking forward to 'getting very active' when the bill hits the Lords.

But he will not always take the government line.

'Am I broadly unhappy with the broad direction of government policy? No.Will I bring an enquiring mind to what the government does in the future? Yes. That is the great thing about the House of Lords - we are to an extent independent spirits.'

There are a number of areas of reform where Lord Hunt was charged to fight an unpopular government's corner in the Lords.

Chief among them was the abolition of community health councils, with the peer, as a former CHC secretary, accused of betraying his past.He sighs deeply. 'It was the most depressing two years... all that energy put into trying to protect CHCs when it should have been put into improvements in public involvement.' But was killing off CHCs the right thing to do? For once, Lord Hunt sounds a bit half-hearted.

'I just felt that CHCs had had a go, they'd been around for 25 years and that it was time for a change.'

More recently, he batted for the government during a ferocious round of parliamentary 'pingpong' between the Commons and the Lords which ended last week when penalties for delayed discharges received royal assent.

Vocal critics of the policy included the NHS Confederation and the Local Government Association. Given his new found freedoms, might Lord Hunt be tempted to switch his allegiances?

Definitely not. 'I do not know why anyone would think that. It was a very vigorous battle in the House of Lords'.

He accuses Liberal Democrat Lord Clement-Jones and Conservative Earl Howe of 'putting forward the views of the bureaucracies - the local authorities and health service that couldn't get their act together - and we were putting the patient's case'.

So what can Lord Hunt say now that he could not when he was a minister?

He laughs, and does not immediately rise to the bait. But he concedes there are areas in which the health service remains weak, and where the government's intervention has not always been effective.

'The fact that we had to intervene in a micro-managed way over cleaning and food shows that operational management has not been given strong enough support in individual trusts and we are weak on some of the basics.'

So presumably media-friendly initiatives like the modern matrons and hospital food programmes should not have been necessary?

'It is absolutely ludicrous that we had to intervene. I know people would say It is all down to competitive tendering with the last government - and That is true about some cleaning contracts - but issues to do with food. . . That is down to good management. The poor old catering managers, who I think are great, have been isolated and not listened to, not had access at board level.'

At a more senior level, he believes the issue of leadership is being taken seriously by the centre, and says the NHS has 'definitely got a good cadre of people who are excellent'. But he suggests 'the jury is still out' about whether there are enough good people to manage the significant roles in acute trusts and, more particularly, in primary care trusts.

What are the obstacles to NHS reform? Lord Hunt lists three: shortages of doctors and nurses, capacity and 'tackling the innate conservatism in the health service'. He believes the service is seeing significant progress on the first two. But the third is host to some sticky issues, including discontent over the GP contract, hot on the heels of the consultants' rejected deal.

Lord Hunt hopes policies like foundation hospitals will be key to addressing wider cultural issues which the contract wrangles throw into relief: 'The downside of a monolithic national service is that it has bred a sort of cultural dependency which expects to be done to, rather than having the confidence to really lead change itself.'

Of all the issues in Lord Hunt's ministerial portfolio, IT was one of the most intractable issues.

The peer concedes that it is only now at the stage of development that the quality agenda was in 1998, when the roles of the National Institute for Clinical Excellence and the Commission for Health Improvement were proposed.

But he insists it has turned the corner, with decisions in the last year giving IT cash, a national programme and a czar in the shape of Richard Granger.

That said, 'obviously it is going to be a very tough challenge and I think that when people in the field wake up to the implications of a nationally driven service there may be some squeals of anguish, ' he warns.

Not that he will be there to pick up the pieces. Lord Hunt has got over the guilt felt in the first two weeks since he resigned 'that I just wasn't getting up early enough' in the morning.Now he is looking to pastures new.

And there is one role on his 'to do' list for which he seems almost over-qualified: 'I would like to chair a trust or health body. I've never done it and I would love to.'

Watch this space. .