At noon on Mondays, Jeremy Hunt‘s office on the fourth floor of the Department of Health’s Whitehall headquarters fills up. Always hosted by the health secretary himself, the midday meeting focuses on what the department calls “NHS delivery” – that is, how the NHS is performing its vital role.
There are usually 25-30 in Hunt’s room, with a few having to stand because there is not enough space around the table. Top brass from the three key NHS bodies charged with overseeing the health service are always present. There’s also one or more of Hunt’s ministerial team: Earl Howe is a regular while Norman Lamb and Dr Daniel Poulter are semi-regulars, along with Hunt’s permanent secretary, Una O’Brien, and sometimes the prime minister’s health adviser, Nick Seddon.
Those meetings began shortly after Hunt was appointed in September 2012 and have taken place almost every week since.
But last October, amid gathering fears that the impending winter would be very tough for the NHS, he instituted a second regular weekly meeting in his office, on Thursday afternoons, which looks at how the service is coping.
Fewer people attend the Thursday gathering, though the three key organisations – the department’s arm’s-length bodies (ALBs) – always do. They are NHS England; Monitor, which regulates semi-independent foundation trust (FTs) hospitals; and the Trust Development Authority (TDA), an arm of the health department that looks after non-FTs. Civil servants jokingly refer to it as “the meeting of the three Davids” because the three bodies are headed by, respectively, David Nicholson (although he steps down at the end of March to be replaced by Simon Stevens), David Bennett and David Flory.
These meetings are unusual – indeed, unprecedented – and controversial. Until now, their existence had not been reported, nor the concern and annoyance that senior NHS figures feel about them. Some of them see them as evidence of Hunt’s “control freakery” and an opportunity for him to call the organisations together to give them their “orders” for the week.
Such is the health secretary’s modus operandi that Professor Chris Ham, chief executive of the King’s Fund health thinktank, says: “Effectively Jeremy Hunt has become the executive chairman of the NHS.”
Hunt can seek a detailed report into one hospital’s failing finances, ask to be briefed on the planned reorganisation of hospital services somewhere in England – the potential political fallout from the rundown of any hospital so close to the election is a priority –or demand improvements in a hospital’s A&E performance if it is not treating the required 95% of patients within four hours.
There is widespread concern at senior levels of the NHS that Hunt’s tendency to routinely ask the bosses of the ALBs to look into things, take action and then report back on progress takes up much of their week and amounts to unjustified direction and interference in their work. There is an “understated threat in his approach”, according to one NHS insider.
“He’s tasking the people who turn up very hard,” said another senior NHS source.
“You are tied up for many hours after that, especially in producing information on issues he has asked about,” said another, who lamented the “industry of information Hunt has created, going backwards and forwards between the DH and the ALBs”. No wonder, as a senior source said, “the bosses who go feel leaned on”.
An ally of Hunt admits that “Jeremy is very directing at these meetings with the NHS leaders – much more hands-on than Andrew Lansley. He identifies a problem, agrees with them a way of dealing with it and then comes back to them a week or two later to check if what was agreed has actually been done.”
No previous health secretary has held such management meetings. But then, Hunt only needs to hold them because his own government’s radical restructuring of the NHS in England last year dispersed power among a clutch of mainly new bodies, each responsible for certain things, leaving – in theory – no one person or body in overall control.
Until last year, that person was the NHS chief executive, who did his or her best to help keep the service on-track for whoever happened to be the health secretary at the time. Nicholson served five in his eight years. The health secretary was responsible to parliament, but the NHS chief executive used his or her command and control to make things happen.
Things are more complicated now. The highly contentious Health and Social Care Act was meant to make good coalition promises to set up an independent board to run the NHS in England – NHS England – and let it get on with the job of running the service, albeit within parameters set by ministers. On 1 April 2013 Nicholson and other senior civil servants ceased working for the DH and transferred to NHS England, which gets its £95.6bn budget from the DH.
The coalition agreement of May 2010 said that “we want to free NHS staff from political micromanagement”. The then health secretary Andrew Lansley’s NHS reform white paper two months later, subtitled “Liberating the NHS”, pledged that the new independent NHS board would be “free from day-to-day political interference” and that the legislation would “limit the ability of the secretary of state to micromanage and intervene”.
While Lansley believed all that, Hunt appears to think otherwise. “He’s controlling the NHS by controlling all of the key NHS bodies, and controlling the NHS almost despite the legislation,” said one of the NHS’s most experienced powerbrokers.
Professor Ham says Hunt is responding to the fact that Number Ten and the Treasury are very interested in its performance, both clinically and financially in the run up the election. However, he adds: “Senior NHS leaders have expressed concerns about Jeremy Hunt’s very close involvement in the running of the NHS.”
One NHS insider said: “Hunt has completely reversed Lansley’s philosophy that problems in the NHS were nothing to do with him or with politics. Instigating the Thursday meetings showed he wanted to do everything he could to avoid a crisis. His approach is, ‘if there’s a problem in the NHS, we get in there and sort it out’.”
The outgoing Nicholson’s second ever tweet, when he finally joined Twitter on 30 January, was an in-joke to fellow NHS leaders. Responding to a spoof tweeter called Jeremy_Twunt, he wrote: “Hello, Jeremy. Any instructions for the weekend?” After initially attending the Monday meeting some weeks, Nicholson declined to continue. His deputy, Dame Barbara Hakin, usually goes instead.
Well-placed NHS sources say that she is the one among the senior regular attenders who enjoys pursuing Hunt’s concerns. “Barbara loves it. She has no problem with being tasked. She loves to see herself as Hunt’s right-hand woman – his deliverer.”
Unusually, while notes are taken at these meetings, no minutes are made or circulated. However, a series of “action points” – specific tasks the ALBs must now pursue – are agreed instead.
Hunt’s highly interventionist style has created resentment and led to rows. “There was a sense that this was direct operational interference by the secretary of state in the operational management of the NHS, which is unprecedented,” said one senior source.