JEREMY Hunt has just accepted one of the toughest jobs in British politics. Coming from the Department for Culture, Media and Sport to the Department of Health, he moves from a department with a total budget of £2bn to one that spends £100bn each year. His new brief involves running one of the largest organisations on the planet and being held personally responsible when anything goes wrong anywhere. It will make the Olympics feel like a walk in the park. The question is: what kind of health secretary does Hunt want to be?
If Andrew Lansley was an architect, Jeremy Hunt needs to be a radical visionary.
Lansley got a set of health reforms onto the statute book in the face of bitter opposition from the health unions. Many will say that the job for Hunt is one of implementation – simply to make those reforms happen and manage the more reactionary unions like the British Medical Association. He has an unenviable task in getting to know the new system and completing the reforms.
Lansley had ten years in the health brief, both inside and outside government. Hunt doesn’t have that luxury, as he tries to grips with the health service. Over the next few months, all sorts of new organisations will open their doors for business. There are new commissioners, purchasing health services on behalf of their patients. And there is a complex tangle of hospitals, general practices, regulators, unions and much more that Hunt needs to master – and master fast. But the real deal lies not in structural changes, but in service transformation.
Since 1948, every government has been able to pump money into the health service to keep the doors open. Now that is not an option. The NHS needs to make £20bn of productivity savings over the course of this Parliament. Hunt’s in-tray will soon be filling up with reports of hospitals facing closures and GP surgeries turning away patients as tighter budgets begin to bite. This government has already had to take one hospital into administration and as many as 20 others are set to follow. Given that Hunt has previously campaigned to save his local hospital, he will now need to completely change his mindset.
Rather than be a safe pair of hands, like Labour’s Alan Johnson, he needs to look to Alan Milburn for inspiration. Like the Blairite Milburn, Hunt inherits a service in crisis. Like Milburn, who introduced choice and competition and invited private companies to run hospitals and clinics, he needs to place all options on the table. The battle to save money will go way beyond the stock solutions, like freezing pay and cutting management costs here and there; Hunt will need more ideas to get more for less.
Many other countries have undertaken reforms that should give the new health secretary cause for optimism. In Valencia in Spain, private companies have been contracted to run joined-up healthcare services. By using sophisticated IT and reforming the frontline workforce, private companies have managed to save the state 25 per cent and improve patient care. While nearly all NHS hospitals are run by the public sector, in Germany there is a real market, with a third of hospitals run by companies and another third run by charities. Privately-run hospitals have been able to reduce costs by introducing their own pay and terms and conditions for staff.
Attempts to expand competition in the NHS have encountered fierce opposition in the past, yet the success of the privately-operated Hinchingbrooke NHS hospital in Cambridgeshire shows what is possible. After six months in charge, the new provider Circle has turned the hospital around and recently secured the joint highest rank among patients in the region. Hunt should look to accelerate this programme.
If the Prime Minister is hoping that Hunt can keep the NHS off the front pages for the remainder of the Parliament, then he has another thing coming. Nor should that be Hunt’s aim. His aim should be nothing less than trying to transform the way we run health services in Britain.
As he emerged through the doors of Downing Street, the new health secretary said his new job would be a “huge task”. In that, he is certainly not mistaken.
Thomas Cawston is research director at the independent think tank Reform.