The Jeremy Hunt cartoon: Jeremy Hunt picks the perfect time to push the contract button
The length of time Hunt spent in Downing Street on the morning of his appointment may indicate the depth of the new prime minister’s concern about what she faces in the NHS.His first priority must be to end the dispute with junior doctors. The new administration is already fighting on too many fronts; medical staff back on picket lines is a problem it will be desperate to avoid.Hunt announced that he was going to impose a new contract on the doctors after the deal he negotiated with the BMA was rejected in a ballot. The dispute is more than just discordant background music; junior doctors feeling alienated seriously impedes reform of NHS services.
Crucially, Hunt stands accused by the doctors of misrepresenting evidence about hospital patient outcomes at weekends, and how that relates to the seven-day working he wants to introduce. If he is going to make any progress in rebuilding trust and finding a way forward which does not involve more strikes, he would be wise to concede some mistakes in the way he has handled the dispute. The alternative is to continue a trial of strength, which everyone loses.
The doctors’ anger is just one symptom of the health service’s chronic staff shortages; it needs more, not fewer, from the EU than the current 55,000. Maintaining the UK as an attractive place for European clinical talent to live and work is a serious problem as Brexit begins to take shape. Hunt needs to have a clear voice in the negotiations.
The biggest problem is, of course, the money. King’s Fund analysis indicates providers and commissioners ended the last financial year £1.85bn in deficit. The creative accounting which, according to the Health Service Journal, shaved around £900m off last year’s deficit total is not a trick that can be endlessly repeated.
With NHS Improvement pressing hard on staffing budgets, the NHS may be about to enter yet another downward plunge in its repeated cycle of boom and bust staffing levels. Constantly hiring and firing staff is clinically risky and financially stupid.
The apparent abandonment of the totemic policy of balancing the government’s budget by the end of this parliament might offer some modest respite, although we are unlikely to know what this policy change actually means until the autumn statement. But it is hard to imagine it delivering a substantive increase in health and care funding, and even the NHS sees the case for social care getting any extra cash first.
NHS England chief executive, Simon Stevens, is intent on reminding ministers of promises made during the EU referendum campaign about more NHS funding, but even if the government were to make a token increase on the back of Brexit, that is still more than two years away.
There is a desperate need for the government to inject some honesty and openness into the debate about health and care funding. If we can have a national debate about the EU, surely we can have one on what sort of health and care service we want, what sort of old age we want, and what we are prepared to pay for it.
Hunt will finally have to publish the government’s childhood obesity strategy – already six months late. The last budget included plans for a levy on drinks with added sugar from April 2018, but far more robust action will be required.
On top of the existing difficulties, May’s speech on the Downing Street steps put further pressure on her health team by stressing her determination to tackle inequalities in life expectancy and providing better life chances for those suffering from mental illness. Pledging to increase the life expectancy of the most disadvantaged is not credible while investment in public health is being cut.
Hunt has done well to survive a brutal cabinet reshuffle, but he should not take that as a licence to plough on regardless. He needs to reestablish trust with the staff and honesty with the public.
We don’t trust you Mr Hunt. What a pity you did not get moved on…