Friend or foe: can doctors trust Jeremy Hunt with the NHS?BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6071 (Published 07 September 2012) Cite this as: BMJ 2012;345:e6071
Jeremy Hunt’s first steps as health secretary for England were inelegant. He tripped this week over a parliamentary early day motion that he had signed five years ago supporting homeopathic hospitals and also a letter to a constituent supporting homeopathy.
The Department of Health claimed that his views had “moved on,” but it is a stumbling start that will focus attention on whether he bases his decisions on evidence. As one prominent medical figure put it: “This has attracted considerable comment. He needs to remember doctors are scientists. There is now considerable scepticism [about him], and he will have to prove himself.”
Among other forays into health he has contributed to a book describing the NHS as a “60 year mistake” (but was more sanguine about universal healthcare), and he voted for the abortion limit to be cut from 24 to 12 weeks.
The MP for affluent, rural South West Surrey has campaigned to protect local services—Haslemere Community Hospital and the emergency department at Royal Surrey County Hospital NHS Foundation Trust—and supported shifting the weighting of health funding allocations away from deprivation.
As chairman of the BBC Trust, Michael Lyons saw Hunt at close quarters while he was culture secretary. He described the minister as “very bright and engaged in what he is doing—he can be very enthusiastic about things which catch his interest.”
He also has a hands-on approach, said Lyons: “The history of the health service is ministers who believe they are expected to solve the problems of the NHS personally, and Jeremy will fit into that mould.”
The extent to which Hunt is “hands on” will have wider importance than just his own term of office. He will be the first health secretary to give a mandate to the NHS Commissioning Board to set its own priorities. He is then supposed to step back from day to day oversight of the NHS to concentrate on areas such as public health. If he still interferes, he will be setting a poor precedent.
Lyons described Hunt’s approach as “pragmatic rather than ideological, but having said that he has a strong faith in markets and [will] believe that the private sector could do more in the NHS.”
He had warmed to Hunt’s style, finding him “charming and engaging even if you disagree with him. It can be enjoyable even if you are diametrically opposed.”
Hunt will need to bring his considerable charm to bear on repairing the damage caused by Andrew Lansley’s unerring ability to alienate people that he needed to win over. Alastair Henderson, chief executive of the Academy of Medical Royal Colleges, said, “There is a huge job to be done around rebuilding the confidence of whole groups of stakeholders.”
Hunt has a reputation as an effective negotiator. He is tough but realistic, tending to see the need for a deal to offer something to both sides rather than pursuing outright victory whatever the consequences.
His mix of engagement and pragmatism offers hope of a solution to the dispute between the government and the BMA over pensions, but any moves to follow his market instincts such as by promoting regional pay could provoke conflict.
One of the biggest risks in changing health secretary halfway through a parliament is that such momentum as there is for service reconfiguration will be lost, as the long term needs of the NHS give way to short term electoral considerations. Jonathan Fielden, medical director (medicine board) at University College London Hospitals NHS Foundation Trust, called on Hunt to provide “strong leadership to back clinically led change.” He highlighted changes to trauma and stroke care and the management of long term conditions outside hospital as needing political backing to win over the public.
Similarly the general practitioner Michael Dixon, chairman of the NHS Alliance, which represents primary care practitioners and organisations, is concerned that a desire to keep health out of the headlines could slow the development of clinically led commissioning: “My fear would be [that he has been] put in for political ideas rather than reform. If it is to be as quiet as possible politically, that would be a pity. I hope the new minister does not take his foot off the pedal.”
Hunt’s time as health secretary could be defined by his response to the final report of the inquiry by Robert Francis QC into the Mid Staffordshire scandal, expected to be delivered to ministers in mid-October. The NHS Confederation has warned the government not to respond to public pressure by imposing ever more inspection and regulation.
But Lyons’s experience of Hunt points in a different direction: “He does not have a natural sympathy with regulators.”
There is evidence for this from his time as shadow minister for disabled people, when Hunt expressed concern about the effect of bureaucracy and regulation on providers of social care.
The Francis report will not be the minister’s only weighty reading in the next few weeks. The report of the Leveson inquiry into relations between the press and politicians is soon to be published. Its findings could damage Hunt.
Cite this as: BMJ 2012;345:e6071
Competing interests: The author has completed the ICJME unified disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.
Provenance and peer review: Commissioned; not externally peer reviewed.