Cowper’s Cut: Jeremy Hunt’s futile gesture

“We need a futile gesture at this stage: it’ll raise the whole tone of the war.”

“The Aftermyth Of War”, from “Beyond The Fringe” 

When you’re trying to solve a problem, you need to be both clear and sure about what the problem is. This may seem crushingly obvious, but it seems to escape some people. It particularly seems to escape some people under pressure.

Those in political charge of the system are neither clear nor sure what the problem is that they’re trying to solve

If a line is worthy quoting, it’s worth quoting for a second column in succession. And there are few lines the NHS needs more than H L Mencken’s from ”The Divine Afflatus”, “Explanations exist; they have existed for all time; there is always a well known solution to every human problem – neat, plausible, and wrong”.

HSJ’s revelation last week that two chief executives had been pressurised into resigning is a depressing reminder that those in political charge of the system are neither clear nor sure what the problem is that they’re trying to solve.

If sacking chief executives (yeah, sure, they resigned …) were a solution to the problems facing the NHS, then the system would have become perfect over the past decade. The system didn’t become perfect, and the problems weren’t solved.

There are times when sacking a chief executive can be the right decision: unfortunately, the system is far from consistently good at noticing when those times are. This led to the “recycling” career pathway for ex-chief executives who take one for the team, in the tacit understanding they will be quietly recycled and rehabilitated after a suitably Trappist period.

A politician under pressure

Sacking these two chief executives is a gesture by a politician under pressure. The sharp eyed will have noticed that the Department of Health issued a statement on Friday that ministers were not involved in these decisions. That statement was promptly rescinded.

Particularly in the case of Mr Kershaw, who has taken on the formidable challenge of leading a series of long troubled trusts, this gesture sends an explicit signal to the chief executive community

There is no point in FOI-ing the minutes of last Monday’s meeting between health secretary Jeremy Hunt and the main system leaders, because the relevant section of the meeting was not minuted. Of course not! Mr Hunt is not a rank amateur. He’s just confused and frightened that things are going wrong.

Which they are. On his watch.

A politician under pressure can be tempted to make gestures. Mr Hunt has yielded to this temptation.

What will these sackings – sorry, resignations – actually achieve?

Particularly in the case of Mr Kershaw, who has taken on the formidable challenge of leading a series of long troubled trusts (South London, Brighton and Sussex and now East Kent), this gesture sends an explicit signal to the chief executive community.

The signal and the noise

Unfortunately, it’s not the signal Mr Hunt was hoping to send: ”if your A&E performance doesn’t improve, you’ll be sacked/resigned”. That would not be a very helpful or motivational signal: it is difficult to think of any provider where the sacking/resignation of a chief executive has improved accident and emergency performance in a politically meaningful timescale.

It exposes him as a man under pressure, who does not understand the problem he is trying to solve

Indeed, a sensible political or system leader would be asking themselves searching questions about why the system is not more effectively supporting providers with A&E problems. There are some good tools, via ECIST and strong analysis from the Nuffield Trust. But they don’t, because that would raise a lot of difficult questions about the system’s change management capacity and capability.

No, the signal it sends to the chief executive community is ”any credit you may think you have in the bank for helping out with really troubled trusts has just been reset to nil, because Mr Hunt is under pressure from Treasury and Number 10”.

Oh, and I heard a rumour that we’re trying to get more clinicians into management. Jeremy Hunt himself said so in 2013, and then again in 2016. Clinicians are bound to be hugely encouraged by this sort of approach to NHS leaders.

That’s the problem with gestures. You can think you’re being very clear, but your audience may be able to read your body language as well as your semaphore.

Mr Hunt’s futile gesture does not raise the tone. It exposes him as a man under pressure, who does not understand the problem he is trying to solve. It does nothing to help with A&E performance. And it is likely to worsen an already bad situation for morale among the NHS’ leaders, whose job security has always been precarious.