Hunt is sticking to the letter – if not the spirit – of devolution
Just a few years ago a health service leader could look forward to August as a time to see more of their family and catch up on neglected tasks, safe in the knowledge nothing much would happen. Not any longer.
The middle of a fixed five-year parliamentary term, which has seen major health reform passed and then introduced, should be a time of quiet industry as the new structures bed down. But, as the last month has shown and HSJ long warned, confused reform - which so often missed more pressing concerns - continues to leave a long legacy of constant recalibration of the problems ahead and how they should be dealt with.
Surveying the events of August reveals myriad examples of system leaders still enjoying a close relationship with the drawing board.
‘NHS England has not established itself as the foremost among equals that Andrew Lansley and Sir David Nicholson imagined’
To take just a few examples: on primary care we have seen NHS England reveal challenging plans for primary care and Steve Field appointed the first ever chief inspector of general practice.
On scrutiny, the Berwick report promoted a deep-seated cultural change; while the Morecambe Bay inquiry seemed set on mission creep and the Health and Safety Executive exercised dormant prosecution powers. The goal of commissioning support units becoming standalone, semi-commercial organisations is now being replaced by a very different vision.
Slow off the mark
But one thing, above all others, has become apparent. NHS England has not established itself as the foremost among equals that Andrew Lansley and Sir David Nicholson imagined.
Little wonder when you consider the uncertainty surrounding its leadership. This, of course, is largely down to the significant number of senior people who have left and Sir David’s decision to retire.
However, there is also the question of recruiting the new chief executive. NHS England chair Sir Malcolm Grant and his fellow non-executive directors have set themselves a stiff task in finding a mould-breaker who can also safely steer the ship.
Given that remit, there must be a good chance they will fail in their mission first time around. HSJ would not be surprised to see medical director Sir Bruce Keogh, acting deputy chief executive Dame Barbara Hakin or even Sir David himself caretaking a year from now.
Into the void created by NHS England’s internal problems has rushed the Department of Health and, in particular, the energetic and ambitious health secretary.
One very senior NHS England director confided to HSJ that the DH’s quick thinking is keeping them - and others - firmly on the back foot.
Hunt keeps a firm grip
Jeremy Hunt is chairing weekly meetings with the heads of all major NHS agencies in which he is very directly demanding to know “what is being done” about problems reaching as far down into the service as the fate of individual trusts.
‘One very senior NHS England director confided that the DH’s quick thinking is keeping them firmly on the back foot’
HSJ’s NHS England source said personal experience had revealed a health secretary capable of sticking to the law of the newly devolved ways of working, but showing very little interest in upholding their spirit.
Mr Hunt would no doubt say pragmatism requires the DH to keep a tighter grip on things (oh, the irony) while NHS England gets on its feet, and that the reforms make it very clear his job is to hold all relevant agencies accountable.
But the long and the short of it is that the government intends to manage what it sees as the key issues facing the NHS - such as A&E performance or the public perception of quality - as closely as it ever did.
Andrew Lansley’s greatest political triumph was making the electorate feel safe with Conservative stewardship of the NHS in the run-up to the 2010 general election.
Mr Hunt believes that only by being seen to actively intervene in efforts to improve NHS performance can he repeat - and even top - that success.