Lintern's Risk Register: Jeremy Hunt – the patient in chief

Jeremy Hunt should by now have completed 100 visits to NHS trusts as part of his pledge to visit all trusts to talk specifically about patient safety.

These visits include a presentation from the trust medical director, before the secretary of state delivers his own talk on patient safety in the NHS and the policies being pursued by the government. Staff then get the chance to ask questions.

These visits are not the usual stage managed political visits. They are designed, as Mr Hunt told HSJ, to “send a message” to the trust’s leadership and staff that patient safety must remain a priority. That it is Mr Hunt’s priority.

I observed a recent visit to Epsom and St Helier University Hospitals Trust. Mr Hunt spoke for 40 minutes, starting with some examples of patient harm that clearly convinced him safety was what would define his time at the Department of Health, post-Francis report. He explained why he believed imposing the Care Quality Commission ratings system was right and why he did not support other changes, such as minimum staffing ratios for nurses.

Mr Hunt avoided slipping into the role of a politician giving a stump speech and instead spent a long time explaining his thinking about culture and the need for change in the NHS. It was not all about his policies and decisions, nor was it an entirely positive talk. He accepted the challenges around funding, social care, recruitment and fears of speaking up. Of course, there was lots Mr Hunt didn’t mention, and this briefing has previously taken him to task on the areas he should be paying attention to.

Built on sand?

What was striking was how Mr Hunt appeared less like a politician and more like a service manager or policy leader. He no longer needs notes to speak for 40 minutes on complex safety issues – he knows it in detail. At several points, it was clear he was preparing to finish but something else came to his mind that he felt was important to share, so he would speak a bit more with clear enthusiasm for the topic.

He was right when he said the NHS faces a choice. The Mid Staffs report was published five years ago and the NHS can either let that become history and move on to something else or it can push further on safety, given that the levels of real harm remain far too high.

Mr Hunt has the air of a minister who knows he’s on borrowed time – as he told the audience, he will not be health secretary forever. But as he approaches being the longest serving secretary of state for health, Mr Hunt has a confidence that can only come from having successfully told the prime minister he is not going to be moved and being immersed in his brief for half a decade.

It’s not a bad thing for a health secretary to have such a focus on safety and be at the height of their powers. Many have failed to really grasp this part of their role. Perhaps, the only benefit of the Lansley reforms was to make it easier for the health secretary to become effectively the patient in chief – which Mr Hunt is clearly enjoying.

But many challenges remain on patient safety despite the substantial progress being made. Mr Hunt will need to marshal all his experience to ensure the government’s austerity measures do not reveal the temple to safety, which he has been so keen to construct, is built on sand. His lobbying for a longer term funding settlement and an end to the 1 per cent pay cap suggest he knows this too.