Has Jeremy Hunt been health secretary for too long?

Three months from now, barring an act of God, Jeremy Hunt will become the UK’s longest serving secretary of state for health. In his job, longevity is an achievement in itself and a sign of wider success. But it is also a danger; as with every passing day the incumbent accumulates baggage that restricts movement and hampers effectiveness.

Since the election, Mr Hunt’s incumbency has shown every sign of following this pattern. His credibility has taken a series of damaging knocks, some through events beyond his control, some of his own making. He stands at risk of losing for good the grip he showed on the health agenda in the previous parliament.

This editorial does not demand a change in health secretary: HSJ has always argued in favour of continuity of leadership, and Mr Hunt’s judgement has, in general, been sound.

Nor does it speculate that such a change is imminent: Cabinet ministers are not removed when locked in battle with unions or delivering manifesto commitments, as the health secretary is doing on seven day care.

It does, however, chart the ground Mr Hunt has lost in past months, and which he must now recapture if he is to lead the agenda he still hopes to deliver in the post.

The perils of longevity

Many politicians are undone by the passage of time, and the problems it inevitably brings – “events dear boy, events” as Harold Macmillan said when asked what kept him awake.

At the start of a minister’s term, when energy levels are high and the previous incumbent or government can take the blame, these “events” can be circumvented, or even harnessed to give momentum to policies.

The past nine months have been marked by a series of unforced errors on the part of the health secretary, arising from his relaxed style (so effective earlier as a contrast to the insular Mr Lansley) and what often appeared to be poor briefing

Mr Hunt skilfully drew much of the sting from the Lansley reforms, and proved equally adept in using the Francis report to develop a focus on patient safety which has saved and improved many lives. He quickly formed an effective partnership with NHS England chief executive Simon Stevens, winning extra billions for the NHS as a result, and has been a determined champion for greater use of technology in healthcare.

Things have been different since the general election.

NHS performance is stumbling, though not yet collapsing; NHS finances are in freefall, in part due to the way post-Francis safety measures were implemented; most of next year’s hard won funding increase will be spent patching deficits; productivity is falling; deteriorating workforce relations have opened into an extraordinary rift with junior doctors; and public satisfaction with the NHS is falling (albeit still high in historic terms).

This gathering sense of gloom was powerfully summed up by the hugely respected US academic Don Berwick, who was commissioned by Mr Hunt to review NHS patient safety in 2013. Addressing the first ever NHS Improvement conference earlier this month, he said the “magnificent” NHS was under-funded and “in trouble”. He told the assembled trust chairs and chief executives: “You have to reaffirm the original vision of the NHS as a service to meet need. I think that’s at risk now”.

Unforced errors

The past nine months have been marked by a series of unforced errors on the part of the health secretary, arising from his relaxed style (so effective earlier as a contrast to the insular Mr Lansley) and what often appeared to be poor briefing.

This matters, because the consequence has been to hamper Mr Hunt’s ability to drive forward his agenda, which – it is worth repeating – is broadly a good one.

When Mr Hunt appeared on the Marr show earlier this month, the eponymous host was able to use those errors to overwhelm the health secretary. Mr Hunt’s announcement of a £4bn pot for NHS IT was afforded one perfunctory question, the key message lost amid an argument over mortality statistics.

Making the junior doctors contract debate about seven day working was a serious strategic mistake. Mr Hunt knows the consultant and GP contract discussions are much more important in this area and, should he momentarily forget, his senior medical advisers would be happy to remind him.

The current spin du jour, that anger felt within sections of the service is the fault of social media, is simply a new version of the age old desire to blame the messenger

The offer on the table for junior doctors is a good one – probably better than the British Medical Association deserves after a campaign of intransigence, spin and obfuscation certainly equal to anything the government is guilty of. There is also little doubt the local leadership of the NHS would like the row resolved as soon as possible.

But instead of the government claiming the high ground we have a situation where apparent support for the health secretary’s position among trust chief executives can disappear in a twinkling and, in another notable moment at the NHS Improvement conference, there was a striking round of applause for a complaint that the government was “de-energising” junior doctors.

The current spin du jour, that anger felt within sections of the service is the fault of social media, is simply a new version of the age old desire to blame the messenger, and has further irritated junior doctors by implying they are unthinking pawns.

Playing catch up

Mr Hunt’s priorities are getting on top of A&E performance, financial sustainability and delivering the changes envisaged by the Five Year Forward View. This is the right agenda, but a challenging one. He cannot afford to have energy absorbed by struggles that do not bring the health service closer to these goals.

The health secretary’s hope is that imposing the junior doctors’ contract will mean this drive is not bogged down by a protracted industrial dispute. It is a high risk strategy that will need more than wishful thinking or the clunking fist of regulators to deliver. At the moment Mr Hunt is playing catch-up, and once the agenda slips your grasp it can be impossible to reel back in – just ask Andrew Lansley.

A week is a long time in politics and the news agenda will move on. The post EU referendum reshuffle is likely to see Mr Hunt remain in post and he has told HSJ of his ambition to stay until, at least, 2017, and deliver further improvements.

To fulfil that ambition, however, he must find a way to rediscover the energy, sure-footedness and focus of the previous parliament, and create a narrative that makes his interventions effective. This is not an impossible task for a health secretary that has often confounded expectations. But it may be the most difficult one he has faced in his long tenure.