So says Jeremy Hunt, Secretary of State for Health, later Secretary of State for Health and Social Care, from 2012 until 2018. On 3 June 2018, Hunt became the longest-serving Health Secretary in British political history. (The portfolio of social care in England was reinstated in January 2018).
Jeremy Hunt www.theguardian.com
The three biggest challenges facing the NHS are workforce shortages, a struggling social care system and persistent issues with safety and quality, the latter highlighted by the worrying Ockenden review into baby deaths in Shrewsbury and Telford. The shake-up announced by the health secretary, Matt Hancock, does not completely solve any of these issues. Some people are asking, reasonably enough, if it is therefore the right time for such an upheaval, not least with NHS staff exhausted by a pandemic that has lasted far longer than anyone expected.
At the heart of the new reforms is the abolition of clinical commissioning groups (CCGs) – unloved administrative bodies few have heard of, which have the legal responsibility to buy NHS care in every area. They are to be replaced by larger “integrated care systems”, which have an equally jargony name. But curiously this obscure-looking change should help to address all three of those big NHS challenges.
NHS staff feel frustrated they cannot deliver more joined-up care to the growing number of older, vulnerable patients who often have more than one thing wrong with them at the same time. If the new integrated care systems mean better links between hospitals, GPs and community care, staff will feel more motivated, because they can do a better job looking after patients, particularly if they can deliver more preventative care that keeps people out of hospital in the first place.
Social care reform is long overdue, and this bill does not give the social care system a 10-year plan like the NHS has. Nor does it stop families who are living with dementia losing their savings, or provide a penny of extra cash. But the new structures, unlike the CCGs, will sit along local authority boundaries and make it much easier for the NHS and social care systems to merge. Local authorities will have a seat on their boards, so single electronic health and care records will be much easier to set up. This will make a big difference to patients currently having to repeat their story to every new clinical team they see.
But it is on driving forward recent progress on the safety and quality of care that these reforms will really be judged. As health secretary, I introduced Ofsted-style rating of hospitals and other NHS organisations to stop another scandal such as Mid Staffs, and to change the culture of an NHS dominated by targets. By the time I left, 3 million more patients were being treated in good or outstanding hospitals. But how will patients know if their new local NHS system, supposed to be joining up hospitals, GPs and community care, is doing a good job? How will they know, for example, if cancer networks are being set up to speed up diagnosis – essential if we are to improve to French and German cancer survival rates?
With such a lot of taxpayers’ money at stake, it is essential the Care Quality Commission (CQC) is allowed to give the new bodies independent quality ratings, just as it now does for hospitals. Hancock indicated to me in parliament that he plans to do this, but we will need to scrutinise the details. The last thing the NHS needs is unaccountable local monopolies.
Nor should the risks of this new plan be underestimated. NHS restructuring rarely works out as intended, as I know from my own experience. We must avoid the jobs merry-go-round that happened last time, with managers accepting huge redundancy payments only to be re-employed a few months later. The politics, too, are risky, with Labour always tempted to turn any reforms into a secret privatisation conspiracy story. However, I would not expect that from the shadow health secretary, Jonathan Ashworth, given his strong track record of constructive opposition.
The biggest risk of all is that setting up new statutory bodies becomes an enormous distraction. That should be mitigated this time because the new bodies already exist in shadow form. But it will need an iron grip from ministers and NHS leaders over the next year to make sure the focus of all NHS managers remains on improving patient care rather than an administrative shuffling of deckchairs.
An NHS restructuring is a brave thing for Boris Johnson to do. But if we are to turn 2021 into a new “1948 moment” for the NHS, as significant for its future as the year it was founded, it is the right way forward, because you have to start by making the plumbing underneath the world’s fifth largest employer fit for purpose. In that context, it shows boldness and vision. But if it is to be as revolutionary as Hancock hopes, it will need to be accompanied by proper workforce reform to boost staffing levels and a long-term plan for social care.
- Jeremy Hunt is the Conservative MP for South West Surrey