Whatever your view of Jeremy Hunt there can be no questioning his stamina. The health secretary, who has already passed his fourth anniversary, shows no sign of running out of enthusiasm or ideas despite a bruising 18 months.
He knows the length of his tenure means he has a rare opportunity to leave a legacy and wants to stay in post for another “two to three years” to deliver it.
During a long interview with HSJ he set out his vision to extend and broaden the successes achieved in the 2000s. Praising the fact “that bringing down waiting times was a guiding light for the last Labour government”, he said: “I want at the end of this decade for the safety and quality revolution to be in the NHS bloodstream so that we really can confidently say we are delivering not just the shortest waits anywhere in the developed world but also the safest and highest quality of care as well.”
He had asked Theresa May to reappoint him as health secretary because: “I knew we were going to have a very tough time financially [but that] if we can keep our focus on safety and quality now we will have it forever.”
At the start of the decade, Mr Hunt’s predecessor Andrew Lansley suggested his job would transform into the “secretary of state for public health” as control of the NHS shifted towards an independent commissioning board and the provider-side regulator. Instead, Mr Hunt has redefined the job as secretary of state for healthcare quality and safety.
Hunt recognises the ability of Westminster politicians to directly control local services is largely illusory
While Mr Hunt is renowned for demanding detail on NHS performance and plans from both national and NHS leaders, he is much less likely than some of his predecessors to actively intervene in local decision making. In this respect he is perhaps a rare example of a health secretary who recognises that, however they may huff and puff, the ability of Westminster politicians to directly control and influence local services is largely illusory.
The starting point of Mr Hunt’s drive on quality is increased transparency. He described last week’s Care Quality Commission State of Care report as a “grim day’s reading for the secretary of state”, but added that “I have never been prouder” as “I am the only health secretary anywhere in the world that actually knows hospital by hospital, surgery by surgery, care home by care home, how good the quality of care is.”
He remarked: “The transparency agenda inevitably is very challenging when you start down that journey because you’re airing the NHS’s dirty linen in public for the first time.”
Mr Hunt praised the way the NHS had “been responding incredibly conscientiously and diligently when it sees that patient care needs to be improved” and singled out Colm Donaghy and Jackie Daniels, chief executives of Sussex Partnership Foundation Trust and University Hospitals of Morecambe Bay Foundation Trust respectively, for the way they had dealt with recent care scandals.
Mr Hunt is very clear on what he sees as the limit of his responsibilities. This includes making the case for local service change.
He told HSJ: “I would be happy to go on [BBC Radio’s] Today programme and say there will always be a need for the NHS to evolve and that will always mean there is a need to do some carefully thought through reconfigurations.”
Citing the example of stroke service redesign, he said: “What matters is not getting to any hospital in the fastest possible time but getting the right care in the fastest possible time.”
He also claimed: “If you look at my track record I don’t think you will find a time when I have not supported a difficult reconfiguration that has been the right thing for local patients.”
However, when it came to arguing for a service change Mr Hunt said the NHS itself must step up. “People always want the politicians to play less of a role in absolutely everything except when there is an unpopular decision and then it’s ‘can you play more of a role?’ I want the whole process of change to be led locally because that is when it is most acceptable to the public.”
This approach should extend to keeping local MPs onside, he added.
“It is too easy to say it’s the job of the local MPs to persuade their constituents these are changes that are needed. The better the NHS is at persuading local populations that changes are going to improve the healthcare they receive, the less trouble they will have from local MPs.”
Mr Hunt also warned “NHS colleagues…not to instantly reach for the reconfiguration drawer” when “facing financial problems” as they often fail to produce savings and “can scare a local population in a way which can make it very difficult to achieve wider reform”.
Sustainability and transformation plans will be “more successful in carrying the public with us in the changes we want to make in local health economises”, he claimed, as they would they would link reconfiguration to “things that are important” to people, “like weekend opening of GPs surgeries, bring down waiting times for mental health and the four week standard on cancer that we want to bring in”.
Mr Hunt’s assertions on reconfiguration will raise a few eyebrows, as will the idea that a quality and safety “revolution” can take place in a period of financial austerity, and the health secretary’s assertion that there is “never a binary choice between balancing the books and having safe care”.
His vision may prove to be wildly ambitious. But Mr Hunt is used to being underestimated by the NHS and its observers, and the scepticism of others is unlikely to push him off course.
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