Jeremy Hunt already has lived up to his reputation as a pollitical smoothy during his first 18 months as Health Secretary. He took on a brief that had become dangerously toxic following the launch of predecessor Andrew Lansley’s unpopular NHS reform programme and immediately removed it from the front pages where it has, by and large, remained.
The tactic created some ancilliary benefit on the frontline, where commissioners have been allowed to get on with their work without the national media monitoring their every move. Granted, there are still some big issues to resolve such as the relationship between the beast that is NHS England and its supposedly nimble clinical commissioning groups (CCGs). But finally, there is an air of optimisim in many quarters: maybe, just maybe it is not all doomed to fail.
For Hunt it’s about the “freedom” of commissioners to make decisions based on the needs of people in their communities. He is “confident” that CCGs are improving health and “they will continue to make sure local people get the excellent care they need”.
However, he does offer a note of caution when it comes to relations between commissioners and hospitals. “Anecdotally, I hear that CCGs in some areas are not as tightly joined up with the acute sector as they could be, so there’s scope for some improvement there – but on the whole, the system is working well,” he says.
Much has been said by GP leaders around the balance of funding between primary and secondary care and Hunt says he’s addressing this. “We are committed to investing in primary care and as part of my department’s ambitious changes to the GP contract there will be a reduction of more than a third of the quality outcomes framework (QOF), allowing money GPs currently earn from these targets to be pumped into overall primary care budgets and a new enhanced service.
“To support innovative GP practices to improve access for their patients the Prime Minister announced a £50 million Challenge Fund, which [will assist with] extending opening hours from 8am-8pm, seven days a week.”
Hunt cites the urgent and emergency care groups, where the NHS and social care system work together, as a particular cause for celebration, mentionimg a few illustrations of where clinical commissioning is working well.
A visit to Bath where local GPs have reduced emergency admissions of the frail elderly by 40% through “dramatically stepping up the care they give people in care homes”. Another jaunt to Gateshead revealed how doctors and nurses had set up a year-long pilot project to improve care for nursing home residents, bringing down the number being admitted to hospital.
“Through developing a more proactive approach to care and working more closely with local GPs and community teams, hospital reductions were almost cut in half for the hundred or so patients in the trial,” he says.
And in Greenwich, admissions have been cut by more than 2000 through joint teams of nurses, social workers, occupational therapists and physiotherapists working together to help the patients in the community that need urgent treatment within 24 hours. “Innovations like these show that the NHS can continue to give world class care while transforming the way it works to help older people,” he says.
A major theme of Hunt’s is the care of vulnerable older people. A report is expected from the Department of Health in the coming months while a focus on dementia has led to a commitment by the G8 in December last year for a greater emphasis on research.
With the number of people in England with dementia set to double within a generation, those with an eye on the bottom line see a looming crisis in financial terms and want to pre-empt it.
“I want to make the NHS the best health service in the world for getting a diagnosis for dementia, as well as further improving standards of care,” he says. “As part of my mission to make England a global leader in finding a cure for the disease, I want NHS commissioners to do their bit to help by encouraging greater participation in clinical and social care studies.”
So, he suggests that CCGs try to encourage their member practices – or at least those that feel engaged – to get patients to take part via the National Institute for Health Research.
Although getting patients to sign up for anything may prove tricky in the wake of the care.data debacle. Data sharing in the NHS has a chequered history with the massive overspend and failure of the National Programme for IT. The more recent revelations around care.data – courtesy of The Guardian – showed that not only were patients unaware that their records were being shared with the Health and Social Care Information Centre (HSCIC) but that the monolith was allowing police access without doctor or patient knowledge.
Hunt is aware of the public’s concerns and he is “determined” to “make sure the rules on sharing people’s data in the NHS are absolutely right”.
But he still holds that it’s essential to share data in the NHS. “It was a crucial part of bringing the problems at Mid Staffs to light, for instance. That’s why I fully support care.data… it will allow the NHS to build up a better picture of disease in an area, research new cures and ensure that services are better joined up.
“Alongside a new campaign from NHS England to explain the care.data programme to the public and GPs, we are also changing the law to address their concerns,” he says. “New legislation will expressly prevent the HSCIC from sharing personal information where there is not a clear health or care benefit for people. This makes it clear beyond doubt that the HSCIC cannot release identifiable or potentially identifiable patient data for commercial insurance purposes, for example.”
Although the immediate shock waves of the Francis report have subsided, Hunt is still keen to push for compassionate care of patients.
“In the wake of the Francis report we’ve already seen much greater focus on compassionate care which I’m delighted with, but I want the hardworking staff who’ve made this possible to keep striving to improve the way care is given to patients, to make the NHS one of the world’s best health systems when it comes to treating patients with the dignity and respect they deserve.”
There are huge changes at the top of the NHS as Sir David Nicholson bowed out in March to be succeeded by Simon Stevens, fresh from working as president of the global health division of UnitedHealth Group in the USA.
Hunt is looking forward to working with Stevens, a former policy advisor to Tony Blair, and is “confident that we have a world class health expert who will make a key contribution to the significant challenge of raising standards of care while maintaining financial sustainability”.
“His passion for the NHS goes back many years but he will also add important international expertise as we face the challenges ahead.”
The fact that there is an election on the horizon has always been a concern to those working hard in CCGs. Will all their efforts be unravelled if and when a new government takes over?
Hunt issues a definitive “No”.
“Doctors and nurses are best placed to co-ordinate the commissioning of high quality care for their patients,
by ensuring that decisions are underpinned by clinical insight and knowledge of the healthcare needs of their local community.
“We need to remember that patients and carers should be at the heart of the NHS, through shared decision-making about their care and meaningful involvement in how health services are organised.”
So whether that goes far enough to reassure those CCGs making big and hopefully enduring changes is up for debate but that Hunt has managed to appeal to patients is not in doubt.