Jeremy Hunt has revealed he is “prepared to look at” the future of the foundation trust model and to ensure the purchaser-provider split does not prevent the integration of services, in an exclusive interview marking this week’s 65th anniversary of the NHS.

In a wide ranging discussion with HSJ, the health secretary said the NHS was the fairest, most cost effective, and most transparent healthcare system in the world – and was among the safest.

However, he added the health service now needed to be as “bold” as its 1948 founders in challenging and changing accepted methods of delivering healthcare.

“The NHS is the fairest healthcare system in the world,” he told HSJ. “If you are socially disadvantaged, Britain is without question the best country in the world to be ill in.”

He added: “On financial stability – in study after study – the NHS comes out as the most cost effective.”

Noting that “the NHS continues to be the single biggest reason people are proud to be British”, he nevertheless claimed: “we need to be bold now – as the founders of the NHS where in 1948 – about saying models need to change.”

Asked if he had any sympathy for people who sought private healthcare because of concerns over NHS safety, he said: “No, because I think the NHS continues to be one of the safest healthcare systems in the world”. He stressed his recent speech on NHS patient safety displayed his ambition for it be “even safer”.

On the government’s response to the Francis report and attempts to improve quality and patient safety, Mr Hunt claimed the NHS was “already the most transparent healthcare system in the world in terms of the volume of information we publish, and we want to go further.”

The nation’s whistleblower

He said recent revelations that the Care Quality Commission had not shared important information with fellow regulator Monitor about the commission’s regulation of University Hospitals of Morecambe Bay Foundation Trust had not caused him to reconsider his rejection of Robert Francis QC’s recommendation to merge the two organisations.

He said he rejected the merger to avoid creating a conflict of interest in which one regulator was responsible for both identifying and solving problems. This would have undermined the CQC’s role as the “nation’s whistleblower”, because “if they’re responsible for putting the problem right, then they have an incentive to say ‘this hospital is making good progress’ when in fact in may not be.”

Mr Hunt said the government had not yet determined how it would introduce a barring scheme for NHS and private health care managers who had failed “in their duty of care”.

He said: “We are looking at what legislation is going to be required and whether we are able to find parliamentary time for it.

He added: “It’s not me as health secretary that makes a decision as to what legislation passes through parliament – so I can’t make a commitment for the whole government about future parliamentary sessions. But the government is [still] committed to doing it.”

Referring to both the barring scheme and to proposed new laws making it a criminal offence to withhold information on patient harm, Mr Hunt said the government wanted to achieve a balance that provided public confidence, but was “sensible in terms of the overhead it creates.”

Mr Hunt also responded to NHS England chief executive Sir David Nicholson’s call, in a recent HSJ interview, for the NHS to abandon the “cookie-cutter model” of all public providers becoming foundation trusts and to re-examine in some circumstances the “the straightforward purchaser provider split”.

The health secretary said: “I think we need to be sensible about the fact that you may not want to have exactly the same structure for an ambulance service as you have for a major teaching hospital.

“The fundamental point about FTs is that we believe the way you get organisational excellence is by giving people more autonomy and more managerial independence. But as how you do it – I think we should be prepared to look that.”

On the purchaser provider split he said: “The principle that you need to make sure someone’s spending the healthcare budget on behalf of the patient without any conflict of interest is absolutely sacrosanct.”

However, he said government plans, announced last week, for improving out of hospital care could potentially produce single provider solutions, and that “we need to make sure that, while we respect the principle of the purchaser provider split, it doesn’t get in the way of joined up services.”

“It won’t work if they have one vision and I have another”

Sir David told last month’s NHS Confederation conference that NHS England’s development of a 10 year strategy would protect the health service from “the tyranny” of the electoral cycle.

Mr Hunt said: “I absolutely agree with David that part of the point of setting up NHS England at arm’s length from the department is to take the political heat out operational decisions. When it comes to those operational decisions, I think it is possible – if you have a bit of distance between political masters and the people who do the commissioning – [to] have a longer term view.

“But I’d also say that as health secretary, I have to be accountable for the entire health budget and I also need to have a long term vision for the health service – because that’s what the public are looking for me to articulate.

“We have to work together on a shared long term vision – it won’t work if they have one long term vision and I have another.”

Asked if this was “a partnership of equals”, the health secretary said: “In the end the buck stops with me – I’m the elected politician and I write the mandate and that’s what NHS England works to – and I’m accountable for what happens in the health service.”

Hunt 'prepared to look at' future of foundation trust policy