Views And Reviews Acute Perspective

What would a “responsible health secretary” do?

BMJ 2016; 352 doi: (Published 25 February 2016) Cite this as: BMJ 2016;352:i1133
  1. David Oliver,
  2. consultant in geriatrics and acute general medicine
  1. Berkshire
  1. Davidoliver372{at}

I don’t want this weekly column to become party political. But I do need to discuss (again) the behaviour of Jeremy Hunt, England’s health secretary. I have never seen frontline NHS staff so pressured, finances so parlous, and clinicians’ mood so low. Hunt has told parliament that he is commissioning a review into the poor morale of junior doctors, apparently in denial about his own leading role in its causes.1

Hunt’s lack of insight was apparent in a recent Guardian interview, in which he asserted his commitment to the NHS’s values and funding model, his regard for doctors’ work ethic, and his view that sustained hostility from them just came with the job.2 As the journalist Joan Smith commented, he seems “unembarrassable.”3

Hunt has claimed that making himself the centre of an avoidable industrial relations dispute with junior doctors, and imposing a contract on them, is justified by “several studies” describing higher mortality among patients admitted at weekends.”4 And that causing major unrest among a workforce that was critical to patient care was “what any responsible health secretary would do.”5 But is it?

For starters, as Hunt admits, those studies were international. Are Hunt’s counterparts in the other UK nations therefore “irresponsible” ministers for not imposing a contract?

Next, a responsible health secretary would listen to what the researchers and journals he keeps quoting to justify his policy leap say about their own research. They have repeatedly told him that he’s drawing unwarranted conclusions.6 7 8 He has also implied that the proportion of newly admitted patients being seen by a consultant within the target of 14 hours of admission is far less than the current four fifths.9 Still he carries on with the pre-scripted soundbites.

It has now been revealed that Department of Health analysts (and the commissioned consultancy firm Deloitte) told Hunt that his proposed seven day service would cost around £1bn and that the cost-benefit analysis couldn’t justify the change.10The BMJ recently reported similar conclusions from respected health economists.11 He’s selectively deaf to evidence.

A responsible health secretary wouldn’t needlessly hamper negotiations with NHS Employers by suggesting that doctors didn’t work at weekends and evenings already,12 nor by inflammatory tweeting when a doctors’ strike had just been averted.13 Nor would be continue to cite an “electoral mandate” for a seven day NHS with no credible, costed, staffed plan to that end.

No. A responsible health secretary would respect objective evidence, listen to advice, and admit that even maintaining levels of performance in acute and primary care would be a remarkable achievement. He might listen to NHS England’s own lessons from hospitals that have moved towards more seven day services,14 which have worked with their clinicians, not changed contracts, and required no extra resources.

Of course, what a really responsible health secretary would do is to realise that he had lost the trust of the NHS workforce and resign. Once the review of doctors’ morale is complete he may have little choice.


  • Competing interests: None declared.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • Follow David on Twitter, @mancunianmedic


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