So, Lansley has moved off the NHS map and Hunt rules ok. But what difference will this make on policy?
So, Lansley has moved off the NHS map and Hunt rules ok. But what difference will this make on policy?
Having worked for many years in the NHS, one of the things I have come to realise is that Secretaries of State are not the all-powerful beings we sometimes think they are. Their power is transient and contextual. Transient because they are all time-limited, and contextual because it depends on the position of the government of the day and the wider issues at stake – such as the economy. Lansley will be remembered for good or bad for the major reforms heralded in the Health and Social Care Act – but the detail was taken out of his hands by the Prime Minister during a disastrous passage through Parliament, and the implementation now rests with the seeming all powerful David Nicholson and his rapidly expanding team at the NCBA.
So to Jeremy Hunt. What will he do? Well, in the short term, not a lot. The architecture for the new NHS is coming into place, and he won’t stop that. A few tweaks of emphasis and language is all we can expect and his track record doesn’t augur well. Here is a Secretary of State on record as backing homeopathy, largely evidence-free, and it is thought Mr Hunt was also involved in a book which called the NHS a '60 year mistake' and said it should be broken up as it was no longer relevant. One of the most important roles of any Secretary of State is to go into battle with the Treasury for NHS resources – but that die is cast and there is precious little, if any, wriggle room.
He faces some pretty big challenges too. He will first and foremost have to keep a grip on NHS spending, deal with the outcome of the Francis enquiry and oversee Cameron’s policy of devolving pay bargaining to local levels. Oh, and yes, he will have to mollify those who believe the government is trying to dismantle the NHS, simplify the message on reforms, and oversee the most far-reaching reform programme in the history of the NHS. In short – try to keep the NHS off the front pages for the wrong reasons. All of this from an individual whose judgment is already in question over the BskyB bid and who has no experience of health.
In the end, the reshuffle is part of a wider political game, and Hunt has not been appointed because of his skills and aptitude for the Health role, but rather as a replacement for Lansley, who could no longer provide the buffer for Cameron. He may look different, sound different, but the underlying direction of travel will be the same. He should remember all of those former Secretaries of State whose names we can’t remember and didn’t make a difference to policy – John who, Patrica something…? In the not-too-distant future he will join their ranks. The real action takes place after the next election, that’s when the future of the NHS will be decided.
