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Hunt in the hot seat

Hunt in the hot seat

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Jeremy Hunt’s large Department of Health office is adorned with a small selection of carefully chosen knick-knacks. There are a few pieces of art on loan from the government’s collection that depict his favourite places (Japan

and Africa). A couple of photos show him meeting his heroes (the pope and Arnold Schwarzenegger). And scattered around are a handful of mementos from his previous job as Secretary of State for Culture, Olympics and Sport, including a section of 10 cm

thick cable that was replaced by skinny fibre optics as part of the role-out of high-speed broadband. Unsurprisingly, references to the scandal that defined that tenure – when he was accused of secretly communicating with News Corp regarding the company’s attempted takeover of BSkyB (a charge he denied) – are absent. He’s now six months into his new role: Secretary of State for Health. Yet on the eve of the largest restructuring of the NHS since its creation, he couldn’t appear more relaxed. Hunt neatly sums up the reforms as being about “taking the politics out of health by giving the big decisions about how local health budgets are spent to doctors and nurses on the front line”.

Sounds simple, doesn’t it? This is exactly why he was parachuted into the health ministry: his predecessor Andrew Lansley was always on edge, skipped from one PR disaster to another and failed to adequately communicate his complex reforms. Leaving that BSkyB snafu to one side, in political terms, hands don’t get much safer than Hunt’s.

In refusing to get caught up in things like ‘detail’, he has taken virtually all the heat out of the debate around the NHS reforms. Best leave all that to NHS England, formerly known as the NHS Commissioning Board, and it’s local area teams.

But now that such an enormous chunk of responsibility for the NHS has moved out of Whitehall, what does Hunt actually do? “I have priorities... dementia, for example; it has been something that we need to do a lot better on, and I put that in the mandate and that is my way of asking the system to do more. I think that is the right thing for me to do as a democratically elected politician; I need to respond to what I think the public think our priorities should be.

“What happened before was that all sorts of matters of health policy became bogged down in controversies about implementation. What we have learned, I think in the last 20 years, is that that public do not really trust changes in local health provision when they are proposed by the NHS managers or by politicians. However, they are much more willing to trust them if they are proposed by clinicians.”

So controversial changes should be made by GPs because the public trust them. But does Hunt have similar faith and, crucially, will he support GPs in making changes to hospitals? “I think they need to decide if they think that is the right thing to do. We have put in place some hurdles they have to overcome before they do anything major, just because it is obviously an area of great public concern if you have a major service reconfiguration,

so we want to know that proper consultation has happened. We want to know it has the support of local clinicians.

We want to know there is a good evidence base, and that it is going to improve patient care. We want to know that it is going to improve choice.”

Hunt says one test that the reforms are working is that “the most intractable problems” are being tackled. “I will give you

one example: the lack of joined-up service in

the NHS, particularly to people who have multiple

long-term conditions such as an elderly

diabetic patient, with mild dementia and a heart condition. There are a lot of people like that in the NHS, and what they do not want is to be pushed from

pillar to post with different appointments for the different conditions they have; they want a joined-up care plan.

“The new structures allow that to happen in a way that has never happened before because so much autonomy is devolved to the front line, to GPs who really know what an integrated care plan looks like. If we see a lot more basic integration and joining-up of services at a local level, that will be a sign that the reforms have really worked.”

That’s a big ‘if’. It depends on clinical leaders maintaining enthusiasm, support from member practices and patients and real freedom to innovate and make unpopular decisions. Yet the findings of the Francis report into the failings at Mid Staffordshire Hospital, small pay increases, staff cuts, financial pressures and increased patient demand are all weighing down on the NHS.

Indeed, a survey of more than 1,000 primary care professionals, carried out by Campden Health, publisher of The Commissioning Review, found that 37% would choose a different career if starting out again and just under half rated there morale as low. While Hunt stopped short of agreeing as much he admitted that it “is very frustrating for brilliant doctors and nurses to see the newspapers full of failures in the NHS”.

It is up to the Department of Health to confront failures which are “the biggest betrayal” when the vast majority are “absolutely brilliant”. He cited the new Chief Inspector ofHospitals as a way of confronting these failings as well as highlighting successes. “We will get what we never really had in health before, which is proper independent verification of excellence, not just the dentification of failure. That together, I think, will create a much more balanced debate in the public.”

But of course the majority of planning will go on in primary care – not secondary. Will there be a Chief Inspector for Primary Care?

Hunt says the idea is attractive, but ”I just wanted to pause before firmly committing to it because I think there are lots of other things we need to think about in primary care as well. I think we now recognise that we have to do a better job at looking after the frail elderly, particularly people with long-term conditions. We do not have proper responsibility for the frail elderly before they get into a critical condition and have to go into hospital. So, I do not think it is always clear, for example, when a geriatrician discharges someone from the hospital that they feel they are discharging someone to someone else’s care. Who that someone else is, is not always clear, and that it why they find it difficult to discharge people. So, I think we have to resolve those kinds ofissues first, and then I think the inspection model is also going to be part of what we want to do.”

The government’s response to the Francis Report called for a duty of candour on organisations, not individuals, to come clean when mistakes have been made. Does that imply a duty on GPs to refuse to refer to services they believe are unsafe?

“I think GPs do need to take responsibility for the services they commission and I think the new clinical commissioning groups will have a big role in driving up standards in hospitals and throughout their local NHS. I also think that we need to have a system where GPs take more responsibility for people when they leave hospital, so that when someone is discharged they are not just being discharged into the ether; they are being discharged into the care of a GP.

“The old model of the NHS was really set up thinking about someone who goes into hospital, is cured and then leaves and goes home. However, increasingly what we are dealing with, with an ageing population, is people that have long-term conditions and so they have very substantial care needs even after they have been discharged. Obviously, that is a role for GPs.”

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