In the new Pf, Health Secretary Jeremy Hunt answers some questions from our readers. Maxine Vaccine delivers a brief audit report on his answers.
The most vital thing to remember about Jeremy Hunt is that he’s not Andrew Lansley. The older man spent nine years dreaming up a transformation of the NHS into a competitive healthcare market system, then claimed he’d had to invent it out of thin air when, as part of the new coalition government, he “saw the books” (which he’d had full access to for nine years) for the first time. Then he drove through legislation designed to break up the NHS and place its fragments on the bargain shelf of global corporate business, and mocked anyone who questioned it. Forced into a cosmetic display of ‘consultation’, he followed it up by declaring that the ‘listening period’ had been needed only to educate the ignorant doctors.
And suddenly, the Tories are faced with the prospect of losing power. Journalists are calling the Health and Social Care Act ‘Cameron’s poll tax’. Cue the new Department of Health. Exit the sneering headmaster and enter the elegantly half-smiling head boy. Who doesn’t half scrub up well, and – unlike Lansley – can say “the NHS is one of our greatest assets” without crossing his fingers behind his back. Jeremy Hunt was a contributor to Direct Democracy (2005), a Conservative Party activist guide that claimed the NHS was “no longer relevant” to modern society because it was a public sector health system. But he can say “the NHS is one of our greatest assets” because he can say anything. Lansley is a Thatcher type of politician, whereas Hunt is a Blair type.
His answers to the Pf questions are classic examples of why he has been drafted in to front NHS reform up to the next General Election, or at least part-way there. He never says the wrong thing. If he can’t say the right thing, he says nothing in a nice way. He makes you feel that anyone who disagrees with him must be insane. It’s only when you compare his words with what is actually going on that things get complicated – and you realise that, as a new lease-holder in the house that Lansley built, he has only unpacked the suitcases for two rooms: the front room and the bathroom. The rest of the house is unoccupied.
Regular Pf contributor Omar Ali asked Hunt a question about NHS rationing: how will making patients pay for services be integrated into the wider healthcare bill implementation? A good question, as this is already happening: patients in many areas are being told they cannot have cataract operations, varicose vein surgery or hip/knee replacements unless either (a) they wait until their need is greater (for example, they can have cataract surgery once they are blind) or (b) they go private. Referral management, which Sir David Nicholson is very keen on, is another form of rationing: if patients want to see a specialist in many situations, they have to go private. Hunt’s response is worth quoting in full:
Let me be absolutely clear on this – the NHS will always be free at the point of delivery and no one will be asked to pay for its services. Yes, in the future, services will be provided differently – public health services will be organised by local authorities, for example – but the founding principle of those NHS services being free, for those who need it, will never change.
Hunt is neatly splitting the hair of Omar Ali’s question. If people are paying for services they are not NHS services, they are private. But money will still be changing hands for services that used to be free. They just won’t be NHS services any more. And that “for those who need it” is significant. It has two aspects: severity of clinical need (already a moveable famine) and ability to pay (Direct Democracy suggests the NHS should become a means-tested state reimbursement of private healthcare fees). Who needs free healthcare, and what free healthcare they need, will be critical issues from now on – and legally, the Health Secretary now has no remit to influence those decisions, which will be made by autonomous CCGs and/or the autonomous Commissioning Board.
Pf reader Susan Ranch asked whether the Government’s recent announcement that it will cap individual payments for social care at twice the Dilnot-recommended level means that more NHS funding will be committed for elderly patients. Hunt replied: This is incorrect. The Government has not said this and no decision has been made. Strictly speaking, he is right. According to the BBC and three Tory-loyal newspapers (the Sunday Times, the Daily Mail and the Daily Express), journalists were briefed that setting the social care payment cap at £75k (whereas Dilnot had recommended £35k) would feature in the Government’s mid-term review. But it did not – and the critical backlash from social and healthcare experts was either unnecessary or effective, depending on your interpretation. Whatever its level, the cap appears unlikely to be implemented before the 2015 election.
Hunt went on to say: I want this country to become one of the best places in Europe to grow old and make sure people can live independent and healthier lives into old age. Which is the kind of gold-plated soundbite Lansley never delivered.
Another Pf reader, Leigh Saunders, asked how the pharmaceutical industry could work with the NHS to improve cancer survival rates. Hunt replied: The pharmaceutical industry already plays a vital role in improving the health of people with cancer. I want to improve mortality rates, where the targeting and development of medicines is becoming ever more important. I am sure the pharmaceutical industry will want to build on its work in this area and help improve cancer care.
Great stuff: that flatters the industry, expresses a decent medical aim, and then flatters the industry again. It doesn’t answer the question, but who cares?
Jeremy Hunt’s management of the Pf questions is a masterclass in accessible spin. It tells us almost nothing about Government policy, but it tells us why Hunt currently holds the lease on the house of NHS reform. He knows how to make it look good – and in politics, that’s not always easy. The pharma industry should recognise Hunt’s talents as those of marketing and sales. He’s one of us.
Maxine’s views and attitude are not necessarily those of Pf.