On the railings of Richmond House in Whitehall hangs a lopsided strip of cardboard that reads, in multicoloured letters, “You just failed the NHS, JH, not us.”
In his spacious ministerial office, two floors above, Jeremy Hunt, currently a hate figure among junior doctors for imposing on them a contract he says they will come to appreciate in time, is explaining that vilification comes as no surprise to a health secretary.
“I was talking to Ken Clarke yesterday and he was saying how he was pursued by nurses to the airport when he was going on holiday with his family – the BMA put up posters of him all over the country. I had a similar conversation with Norman Fowler and someone was telling me yesterday how Patricia Hewitt had the mums of junior doctors pursuing her everywhere she went,” he says.
Had he been pursued? There had been “one or two incidents, but it goes with the territory,” he says, with a polite smile.
It is early in the morning the day after the contract has been imposed, to widespread condemnation and warnings from doctors that they will leave the UK. Hunt, in his trademark immaculate white shirt, is willing to talk about the junior doctors as part of a wide-ranging interview at the close of the Guardian’s four-week series, This is the NHS. The series has been great, he says, and “really human”. He wants to explain his thinking on the NHS and move beyond the “fairly repetitive debates” on fraught political issues like privatisation.
“One of the challenges I have as health secretary is that everything I do is automatically controversial because I am a politician and it’s automatically seen through the prism of ideology of party politics,” he says.
“About a year before I became culture secretary, I had a BCC [basal cell carcinoma], which is a small mole, removed from my head. I was lying flat on my back in Chelsea and Westminster, the surgeon had his knife out and I’d had the local anaesthetic put in and the nurse in the operating theatre looked at me and said, ‘By the way, Mr Hunt, what is it you do for a living?’
“And I froze. I thought – my goodness, is this the moment when I confess to being a Conservative cabinet minister?”
Hunt is laughing at the memory, but turns serious as he takes on the critics who think he wants to sell off the NHS. In unequivocal terms, he pledges his loyalty to a tax-funded health service, free at the point of delivery. He has had “fantastic care from the NHS all my life”, he says, including during the birth of his three children.
“My admiration for the NHS has gone up since becoming health secretary because – despite the many problems – what I think is special in this system is the relationship between doctor and patient where there is no conflict of interest caused by money,” he says.
He references the US, where there are pockets of extraordinary innovation and use of technology, but: “The problem is there is always that question in the back of your mind about whether or not the reason you have been given this advice is to bring in extra revenue for the hospital or for the physician involved – and you know that’s part of the reason why there is a big tradition of consulting two or three doctors in America about every medical ailment.”
What we have, with the NHS free at the point of care, is pretty special, he says, and he would not change the way it is funded. “A single payer system which removes that conflict of interest with respect to money and profit is actually something that has the potential to give us the safest and highest-quality healthcare in the world. I think there is a journey we have to go on, but it has that potential.”
Hunt is from a “true blue family”, he says, the son of an admiral, with aristocratic antecedents, brought up in the picturesque Surrey village of Shere on the North Downs. He was head boy at Charterhouse school and graduated with a first in politics, philosophy and economics from Magdalen College, Oxford. It is an unmistakably privileged background, but, he says, he was taught to value the NHS at his father’s knee.
The NHS “remains the single biggest reason why most people are proud to be British”, he says. “Because we were the first country in the world to say it doesn’t matter who you are – rich or poor, young or old, north or south – you should have access to excellent healthcare and it should never be a question of your bank balance.
“I think that resonates with something we think is deeply British and I do think people on the left completely wrongly assume that no Conservative could ever feel pride in that. We do.”
But the clash with the junior doctors, whose cause was supported by their consultant colleagues and much of the public, has been damaging. Relations with the GPs and consultants are also strained and Hunt will struggle to make his critics believe the NHS is safe in his hands. He says there was “no risk-free option”. They were in deadlock and Sir David Dalton, the chief executive of the Salford Royal NHS foundation trust, who was chief negotiator, “clearly advised that there is no negotiated settlement available”, says Hunt.
The alternative, as he saw it, was to back down and renege on the government’s manifesto pledge to deliver seven-day working in the NHS in England (the contracts have been imposed on junior doctors in England only) “despite the overwhelming evidence we have of higher mortality rates at weekends”. He cites 15 international studies since 2010 – eight in this country.
“You can argue about individual statistics and there’s been plenty of debate about that,” he says, obliquely referring to accusations that he had misrepresented the figures for stroke deaths, but “I don’t think you will find any doctors disputing the fact there are higher mortality rates at weekends.”
He claims he has made a big compromise over the junior doctors’ contracts, agreeing that anyone working one in four Saturdays or more would get paid at a higher rate.
“Right now it’s going to be very difficult for a health secretary to say anything at all that is given a warm round of applause by junior doctors,” he says, but he thinks the mood will change. He believes the doctors will come to realise that the imposed contract is different from the original offer, “substantially closer to what the BMA were asking for”. Morale has improved in those hospitals that have already introduced seven-day working, he says.
“Doctors are happiest in their jobs when they are able to give the best care to patients,” he says. “I think one of the reasons morale is low in junior doctors is because if you go and work at weekends now as a junior doctor – which they do in abundance – it is very tough. There are half the number of consultants working in A&E departments on a Sunday as there are in the rest of the week, despite it being one of the busiest days of the week.
“You might well end up having to work for longer than you planned, you might end up being called in when you weren’t expecting to go in at the weekend and you know in that situation it is tough.”
The junior doctors are angry because “they are probably the hardest-working people in the NHS, working the most evenings, the most weekends and therefore they feel very stressed”, and because the old training structure, where they learned from following and doing the bidding of a consultant, collapsed when the European working time directive limited the hours they worked.
“So I think those two things meant that when there was a contractual dispute – which started with the BMA wrongly telling everyone that the government wanted to cut their pay by between 30 and 50% – it lit a touch paper and I think that is what caused it.”
Hanging on the wall in a corner of the office is the famous whiteboard listing “never events” – mistakes such as a surgeon removing the wrong kidney that should never happen. Seven incidents have been recorded on there from the previous three weeks. It is not a stick to beat the NHS with, says Hunt. “I want to normalise openness and transparency.”
Shortly after he moved into the office, installing a director’s chair with HUNT in white capitals on its black canvas back and a photograph with Sylvester Stallone from his days as culture secretary, he had to deal with the scandal at the Mid Staffordshire NHS foundation trust. Nurses were accused of neglecting patients and falsifying data to make it look as though they were meeting waiting-time targets. There were tragic stories of suffering patients and investigations into deaths. The Francis inquiry report found very serious failings at the trust.
It was a watershed moment for the NHS and profoundly influenced Hunt’s thinking. Bracketing together Mid Staffs and Winterbourne View, the care home where vulnerable residents were abused by staff, Hunt spoke in 2012 of “a kind of normalisation of cruelty where the unacceptable is legitimised and the callous becomes mundane”. Some in the NHS felt Hunt was using these shocking examples of bad practice to attack the entire system. He says he is on a mission to improve the quality of care.
International studies say the NHS is the best in the world, he says, with the smallest gap in healthcare available to rich and poor, but we have tended to think that what matters is access in the shape of waiting times.
“I think we were right to do that in the 2000s under the Blair government,” he says. “I think that government deserves credit for bringing down waiting times and we must make sure, despite the pressures in the NHS, that we don’t compromise that legacy.
“But actually, for the promise of equity to be delivered, we also have to have the highest-quality care. So I think if the first decade of this century was the access revolution, I think the second decade needs to be the quality revolution.”
He credits Lord Ara Darzi, the world-renowned surgeon brought into the Blair government as a health minister, for kickstarting the quality agenda that he is now determined to advance. The first step is complete honesty over where care is not up to scratch, he says. Since he has been in post, 27 hospitals have been put into special measures and 11 have been removed from the list. “I think even my harshest critics would acknowledge that programme has been an extraordinary success and the quality of care in those trusts – though not all of them – has improved dramatically,” he says.
He claims they are doing for hospitals what Ofsted did for schools when it was set up in 1991 and put failed schools into special measures. He cites the recent Guardian story, which showed that affluent parents were now choosing state schools over private.
The second step is to make sure that what is being measured is the actual quality of care – not just the performance of a hospital or mental health trust. And the third is to end the blame culture and make it much easier for nurses and doctors to speak out when mistakes are made. We need, he says, “a supportive learning culture” if quality is to improve.
“In our NHS at the moment, we have stillbirth rates that are too high, neonatal death rates that are too high and too many never events … We have got to learn that we can’t vilify doctors every time something goes wrong. We have to recognise that the most important thing is to learn from what went wrong; that is what every patient says who has had a bad experience or a tragedy.”
Hunt, lean, fit and drinking water, is aware of the need to prevent people becoming patients if the NHS is not to be overwhelmed. He does not suggest, unlike some in his party, including the prime minister, have done in the past, that obesity is a personal responsibility. “The question is whether we are going to do something about it – and I think we have to,” he says. It is “incredibly worrying” that one in 10 people will have type 2 diabetes within a couple of decades.
He will not be drawn on the chances of a sugar tax, which chef Jamie Oliver is campaigning for, other than to say that nothing is off the table. “We are absolutely clear that it is essential that we end up with children consuming less sugar and we are looking at all the options, but we want to do it and we want to do it quickly,” he says, in spite of the delay in the childhood obesity strategy, which was originally supposed to be published in December.
Is the government prepared to get tough with the food and drink manufacturers? “I think that is a choice for the food industry. They could be a positive force in this or they can be obstructive,” he says. Things will move faster if they cut the sugar in their products, “but we aren’t going to have a strategy that relies on them being cooperative. It’s too important and they need to understand that they have to do the right thing.”
He admits the NHS needs more money, but the answer is not a social insurance model, as some European countries have, he says. He was the co-author with a group of Tory MPs of a policy pamphlet in 2005 entitled Direct Democracy: an agenda for a new model party, which called for the NHS to be replaced by health insurance and access to the private sector, but has since denied he wrote that chapter.
Eleven years on, he says the tax-funded NHS is admired for its cost control and he is categorical that insurance is a bad idea, saying that car insurance premiums inflate because nobody has an incentive to keep the costs down.
“The biggest risk to a single payer model when it’s coming through taxation is if the government screws up the economy,” he says. “If you have a strong growing economy, governments always have a choice to put more money into the NHS. It’s what Tony Blair did in the early 2000s. It’s what George Osborne did in the last spending review.
“And as we eliminate the deficit, providing the economy continues to grow, we will have that choice again in the future. I, for one, think we will have to put more money into the NHS, going forward, because of the pressures of an ageing population.”
He could see, he says, “a period of substantial above-inflation increases providing the economy grows” in decades ahead. But for now, he says, they have given the NHS what it asked for and insists it is a good deal.
And with that, the health secretary heads out of the door to catch a train to the south coast for one of his weekly trips to see what is happening on the ground in the NHS. This time it is to a children’s hospice. He may hope that by the time he encounters junior doctors in a hospital again, some of their hostility will have evaporated. That could take quite a while.
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