My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Given the current Secretary of State isn’t playing the role outlined for his job in the reformed structure, which NHS structure is he trying to run?

Filed Under (Coalition Government, Foundation Trusts, Health and Social Care Act, Health Policy, Jeremy Hunt, Secretary of State) by Paul on 05-03-2014

The last 10 months have made it clearer and clearer that Jeremy Hunt, as Secretary of State for Health, can only do the job the way he wants to by completely ignoring the reforms of the NHS brought in by his Government.

We have one of the most activist Secretaries of State for Health of recent years  operating within a legal system – that he helped to create – which grants him very few of the powers that he feels he needs to carry out the role.

There are hundreds of Conservative party quotes attacking targets that I could use but I’ll just take one, from their 2008 document, Renewal.

“The problem is Labour’s strategy of trying to manage the NHS through top down centralised targets. These targets focus primarily on processes and administration such as stipulating the time it should take for patients to be processed through their treatment, or for administrative procedures to be completed, rather than the actual results of patient care”

Phoning up chief execs of NHS Foundation Trusts to quiz them about their A and E performance ignores several bits of the legislation that he helped to get through parliament.

He will of course remember, as he phones the CEO of an Foundation Trust, how para 1.5 of the White Paper “Liberating the NHS” (that he agreed in Cabinet in July 2010) said

“We will legislate to establish more autonomous NHS institutions with greater freedoms, clear duties and transparency in their responsibilities to patients. We will use our powers in order to devolve them”.

I am sure the CEO of the FT will feel, as he is being called by Jeremy Hunt, that he is part of a more autonomous institution…

First let’s get one issue out of the way. There are those that say that Jeremy Hunt’s job as Secretary of State for Health is made much more difficult by the fact that he has to work within a structure created by NHS reforms that reflect the ideas of his predecessor Andrew Lansley – and that he in fact had nothing to do with the structure and the law that he now chooses to ignore.

The argument goes that Andrew Lansley had a very idiosyncratic view of how the NHS should be organised and that given just how individual that was it’s hardly surprising that Jeremy Hunt needs to do something different.

This argument depends upon Andrew Lansley having acted purely as an individual who one day simply implemented his very individual plan.

But it wasn’t like that. That’s not what happened. Andrew Lansley was a member of a Cabinet that discussed his plans on several occasions – and on each occasion the Cabinet decided to go ahead with these plans.

Andrew Lansley was a Member of Parliament who belonged to the party that formed the greater part of the Government. Jeremy Hunt is a Member of Parliament who belongs to the same political party. He voted for the Health and Social Care Act on very many occasions. He signalled his agreement with Andrew Lansley’s plans by voting for them on all those occasions.

So it may be that these reforms were odd, but they were actively supported on many occasions by the Coalition Cabinet (member Jeremy Hunt) and the Conservative Party in Parliament (member Jeremy Hunt).

And my obvious point is that Jeremy Hunt was an active part of the processes that enthusiastically agreed the plans for a new NHS structure that he now ignores.

In Cabinet in July 2010 there would have been a discussion of the White Paper that specifically argued for a much smaller role for the Secretary of State in running the health service.

In Cabinet in December 2010 there would have been a discussion of the biggest Health Bill in history where clause after clause outlined how a new architecture of independent organisations would take power away from the Secretary of State.

In 2011, given the trouble that the Bill was in, there would have been several other Cabinet discussions about the Bill. In each of these the Cabinet collectively (member Jeremy Hunt) decided to go ahead with the reforms.

Jeremy Hunt was an active member of this Cabinet. He was a part of these discussions which collectively agreed to push them forward.

These reforms – which the current Secretary of State now finds it difficult to live within – were agreed personally by him over a long period of time.

They are just as much Jeremy Hunt’s reforms as they are David Cameron’s and Andrew Lansley’s.

Jeremy Hunt’s problem is that the reforms he voted for and passed into legislation created a system which now gives him insufficient power to carry out his work in the way that he feels he needs to.

You might think that the daily spectacle of a Conservative Secretary of State trying to wield powers that he personally contributed to removing from his office, would be a matter for some derision and scorn from Her Majesty’s Opposition.

There are hundreds of quotations about not making top down decisions which could be thrown across the chamber at Jeremy Hunt and contrasted with the need to intervene he seems to feel every day.

The opposition could make him a figure of fun for doing the opposite of what his legislation signed up to.

But they don’t. No one says this is weird because the opposition think that if and when they take over the role of Secretary of State for Health they will also be looking to use as much power as possible to tell people in the NHS what to do. They relish the thought of telling CEOs what they can and cannot do and are rather pleased that they don’t really seem to need legal powers to do that.

Their failure to point this out doesn’t change the rather odd nature of what is going on though.

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