Cynics will dismiss it as a stunt. But for the past few months and with little publicity Jeremy Hunt has been out on the wards. One day each week the Health Secretary has left Whitehall to spend time “working” on the front line of his sprawling NHS empire.
He has answered the phone to patients at a GP’s surgery in Kennington, made the beds on a busy A&E ward and joined the porters as they move patients around hospitals; visiting operating theatres, treatment rooms, and occasionally the mortuary. At one hospital he was even asked to do the photocopying. He couldn’t say no
The idea, says Hunt, is to “see what’s happening on the coalface”. Because unlike his predecessor, Andrew Lansley, who spent six years learning his trade as shadow Health Secretary before getting his hands on the levers of power, Hunt had no political knowledge or experience of the health service before being appointed last September.
Hunt knows he could be undone by a failure to understand the fiendish complexities of the system for which he is accountable. He may have a better political bedside manner than Lansley – but that will count for nothing if another Mid Staffordshire scandal takes place under his watch.
We meet at the Chelsea and Westminster Hospital in London, where he has spent the morning on an A&E ward. It is the day after David Prior, chairman of hospital inspectorate the Care Quality Commission, warned that some A&Es were “out of control” and “unsustainable”.
By all accounts, the unit was under control at the time Hunt visited. But one nurse did leave a message for the Secretary of State: “He’s got to know it’s not usually like this.”
Hunt agrees. “The biggest pressure in the NHS is on A&E. The fundamental problem is that people are not finding it easy to see a doctor out of hours and are ending up in hospital. We also have an ageing population which means we have four million extra people going through A&E than we did in 2004.”
It is a political problem as much as a medical one. Only last week Hunt was accused of trying to find £300m that didn’t exist in an effort to solve the A&E conundrum. As for the coming years, however, Hunt believes that Britain’s ageing population – and in particular dementia – will become the biggest threat to the NHS. He likens the challenge to that of cancer 50 years ago.
To that end he will announce a review on Monday that will attempt to completely rethink the way the NHS offers care to it biggest clients – the elderly.
At the heart of Hunt’s diagnosis – from his visits and meetings – is that the NHS has lost track of what it should be doing. GPs have been incentivised to fulfil tick-box exercises proving they have assessed their patients for certain conditions – rather than looking at their care in the round. Hospitals have been paid “by results” for operations rather than thinking what happens when the elderly lady who has had a hip operation leaves the ward. And most importantly there is no obvious connection between the NHS, which is responsible for health, and local councils, which are responsible for social care.
As he puts it: “In too many parts of the country, social care systems off-load patients into hospital and say ‘nothing to do with us, gov’. They then put up a huge number of barriers to them leaving [hospital]. They say if you want us to take them back you’ve got to fill out this 64-page form and we’ll see if they are eligible.”
What Hunt wants to see is a system where GPs are rewarded for looking after patients when they’re ill and when they’re well, where social services are incentivised to prevent people from ending up in A&E in the first place – and most importantly where everyone who needs it has a dedicated individual to help them navigate the system.
“The really, really important question is who is responsible for people when they are not in hospital?
“Nobody disagrees that there has got to be someone there thinking that 85-year-old Mrs Jones needs this type of care and needs to be visited this often, have physiotherapy, occupational therapy – whatever it is.
“But now we have to make a reality of that – because unless we do that we won’t solve the long-term issues around A&E pressures – and more importantly we won’t give vulnerable elderly people the kind of care we can be proud of.”
So who will that named individual be? Hunt is wary to say – fearful of stoking up the doctors and nurses again, who will see it as more work.
But he does want GPs to take more responsibility for out-of-hours care.
“GPs will definitely be part of the [out-of-hours] system and I think GPs could be a major part of the solution,” he said. “But this exercise that we are going to do between now and October will identify how we can give vulnerable older people the round-the-clock care they need.” In return they will get more freedom to decide how to best look after their patients in a move away from targets to a more holistic approach towards patient care.
“This is part of the much bigger shift the NHS has to make to cope with an aging society,” he says. “The world of the NHS today – unlike 1948 – is a world where a quarter of the population has long-term incurable conditions. They need a permanent care plan, not a ‘here’s the medicine you’ll be better by next Friday’-type approach. At the moment the NHS is set up to deal with curable illness and people going home well – but that’s not the world we live in.
What is interesting about Hunt is that unlike his predecessors – both Labour and Conservative – he seems to genuinely believe that if you remove targets and hand back power to the professionals then better outcomes will follow.
“If you make a GP’s financial reward the number of aspirins they give to patients, you de-professionalise them because you’re saying you’re not going to trust their clinical judgement. You also make it impossible for the GP to treat the person rather than the condition.
“When I was with a GP this morning I was very conscious of the amount of paperwork they had to do. One GP told me she spent two days at work to update four separate computer data bases.
“There should be no hiding place for any professionals who don’t meet the highest of standards – but I do think you have to have faith in the people of the NHS as being people who want to do the right thing. And if we create the right structures, they will do that.”
Interestingly for a man who many thought would simply try and “close” the NHS down as a political issue, Mr Hunt does appear to want to grapple with some thorny problems.
His proposals on elderly care may be sensible but given the huge vested interests across the NHS they are unlikely to pass without controversy. And that’s a big risk for any Conservative Health Secretary.
So how does he want to be remembered? He pauses. “I hope people would say that I was someone who faced up to the big issues. I would like to say that I’m someone who stands up for the values of the NHS when it was founded.”
He won’t win round the cynics. But he does sound sincere.