Jeremy Hunt: New chancellor is the man who ruined the NHS

Plans developed during the Hunt years, most notably “Sustainability and Transformation Plans” claimed that hospital bed closures would be made up for by improved ‘care in the community’. But numbers of community matrons, district nurses and school nurses continued to decline under Hunt, and there had been a dramatic drop in the number of community health visitors by 2019.

This policy failure, during a funding squeeze, is perhaps not surprising – the reality is that care at home requires more, not less, funding than care in hospitals, as reviews by the University of Manchester, the British Medical Journal, the National Audit Office and even the Department of Health itself have shown. Hunt repeatedly ignored the many experts warning him that this was the case. In the end, though, billions of pounds of ‘transformation’ money supposedly set aside to deliver the policy change, instead had to be quietly re-purposed into keeping cash-strapped hospitals just about afloat.

Meanwhile, in vital but neglected areas such as general practice, maternity and mental healthcare, Hunt routinely over-promised and under delivered.

In October 2017, Hunt told MPs: “We’ve got 30,000 more people working in mental health today than we had when [Labour] left office” – a claim that was revealed to be false. Not long before leaving office, he won headlines for promising that mothers would get a ‘dedicated midwife’ throughout pregnancy and birth, although later reports suggested that this wasn’t, in fact, the case, and that women were just being promised ‘one of a team’. In other words, no change.

Hunt called general practice the “jewel in the crown” of the NHS, and in 2015, said: “We want 5,000 more GPs by 2020” – but he backed away from the commitment within days, talking of the need for “flexibility”. According to Channel 4’s Factcheck, the actual number of additional GPs he achieved in the following three years was… 162. By the last year of his oversight, the BMA described the number of GPs leaving their jobs as a “crisis”, with half a million patients seeing their GP surgery close last year.

Perhaps GP demoralisation wasn’t surprising – Hunt described the years of underfunding of GPs as their “penance” for the contract the Labour government signed with them. And just as importantly, GPs’ professional autonomy and connection with the patients was repeatedly watered down. In some areas, they were offered cash incentives to refer fewer people to hospital – including cancer patients. Those who weren’t swayed, nonetheless saw increasing attempts to second-guess their referrals by ‘referral managers’ who haven’t even seen the patients but aimed to reduce their referrals by as much as 30%.

Privatisation – the wrong ‘solution’

Not long before his departure, Hunt told Parliament that NHS privatisation “is not happening” and was “fake news”. But his actions suggest he was as ideologically wedded to continued competition and privatisation (in various guises) as his notoriously destructive predecessor, Andrew Lansley. An enormous amount of clinical and management energy was wasted in having to work to keep services from being chipped off by the private sector – even though such privatisation is a hugely costly process with no proven benefits.

While various privatisations collapsed, failure seemed to be rewarded. In 2013, a privatised treatment facility in Stevenage run by the company Clinicenta was bought back by the NHS following the deaths of three patients during routine surgery, with local officials raising concerns about “serious failings” and “evidently substandard” care. But just as Clinicenta was collapsing, its parent company – Carillion – was rewarded with further NHS contracts including major PFI schemes at Royal Liverpool Hospital and Midland Metropolitan Hospital.

After Carillion itself collapsed, The Guardian revealed documents that showed that, “civil servants working for Jeremy Hunt successfully lobbied the Cabinet Office to stop failing Carillion hospital projects from being overseen by an independent watchdog”.

Similarly, Circle’s privatised Hinchingbrooke hospital collapsed after inspectors found shockingly poor care – but Circle has since been rewarded with other contracts, including the takeover of a dermatology clinic in Nottingham that led to virtually every consultant resigning rather than work for the private firm. The unit, formerly a national centre of excellence, was forced to scale back its services and to recruit overseas locums at a cost of up to £300,000 each. An independent report labelled the contract an “unmitigated disaster”. Then, Nottingham NHS bosses decided to take Circle’s local treatment centre (which provides a range of operations) back in-house, and Circle sued them in response.

From ambulances to eye operations, out-of-hours care to the NHS’s 111 medical helpline, drug treatment and prison services to musculo-skeletal services, private firms cherry-pick cash and ‘easy’ patients from the NHS – leaving the NHS underfunded and struggling to survive.

Virgin Care won almost £2bn of contracts during Hunt’s tenure, including highly controversial contracts to look after children and frail, chronically ill people in many parts of the country. One of his first acts was to personally intervene to help Virgin’s takeover of swathes of services in his own Surrey area. 2018 saw a 57% rise in privatisation cash overall. Hunt also pushed repeated, though ultimately fruitless, attempts to privatise NHS Professionals – the NHS’s own in-house agency and its last line of defence against profiteering temporary agencies – even as he told hospitals to reduce their reliance on agency staff.

Other novel forms of privatisation were also pursued during Hunt’s tenure – from the NHS creating separate businesses for portering and facilities management to “personal health budgets” – an updated version of Thatcherite health vouchers, in which seriously ill patients are handed fixed sums for their healthcare needs and encouraged to ‘shop around’ across the public and private sectors.

The tech bonanza is another novel form of privatisation. Hunt’s successor Matt Hancock has been criticised for an overly credulous attitude to technology, but Hunt laid all the groundwork. The NHS signed substantial contracts with the likes of health app firm Babylon under his oversight, as well as running into a massive controversy over the care.data project in which Hunt and his tech Tsar, Tim Kelsey, were unable to adequately reassure a concerned public that personal data would not be sold to private firms. In what he described as his “most important speech as health secretary”, Hunt boasted that; “The future is here… 40,000 health apps now on iTunes… this is Patient Power 2.0.” The announcement was somewhat overlooked as it was also the speech in which he launched his astonishing attack on doctors (more below). But perhaps Hunt envisaged a future with fewer doctors – not long afterwards, he faced fierce criticism by doctors for issuing “potentially fatal” advice to parents to use “Doctor Google” to diagnose their children’s rashes.

David Cameron sold the controversial 2012 Health and Social Care Act by claiming that it put doctors in charge of decision-making. In reality it put privatisers in that position, along with commercial providers taking over and sub-contracting to the NHS. In 2016, openDemocracy reported on a version of these arrangements called “Accountable Care Organisations”, an idea based on US hybrid insurer-hospital organisations such as Kaiser Permanente. This gives private providers involvement in decision-making about what treatments patients do or don’t receive, and financial incentives to minimise treatment (as Michael Moore’s film ‘Sicko’ exposes). Hunt visited the US firm at least three times.

Hunt told MPs in 2016 that his department was “finding our way forward to the kind of budgetary arrangements that you would have in Kaiser Permanente”, although given the backlash against Accountable Care Organisations, they were… renamed as “Integrated Care Providers”. Hunt also gave the US medical centre chain, Virginia Mason, £12.5m to teach NHS hospitals about safety, calling it “probably the safest hospital in the world” – only to see the US organisation fail its safety inspection a few months later. For all Hunt’s plaudits, neither Virginia Mason nor Kaiser Permanente have anywhere near the cost-efficiency per head of the NHS. During Hunt’s period, concerns have been swirling about the impact of a US trade deal – and the reassurances that the NHS will be excluded from such deals are simply not plausible.

In social care (which Hunt repeatedly promised to ‘integrate’ with the NHS, though he was not directly in charge of social care until the last few months of his tenure), once again, Hunt’s commitment to market ‘solutions’ meant that the discussion was rarely about the real problems. Many of these were, in truth, decades old – including the Tory 1990s legislation that paved the way for much healthcare to be gradually redesignated as social care, thus privatised, means-tested and charged for.

However, Hunt did little to promote the real solution – reintegrating social care under the NHS’s public, free provision. Instead, he suggested that the ageing population was a massive “commercial opportunity” – and ‘integration’ began to look to campaigners like merely code for ‘helping the private care sector get its hands on more NHS cash’.

The underlying issues were left unresolved, the promised social care green paper was delayed no less than five times (and counting), experiments to ‘integrate’ ran into frequent problems, and the social care sector continued being just another convenient scapegoat for delays in discharging people from hospital. Hunt is still pursuing market solutions, suggesting during the leadership campaign that while social care cuts had gone too far, the answer is to ‘incentivise’ individuals to save for their own social care.

Perhaps none of this is surprising. Back in 2005, Hunt co-authored a book called ‘Direct Democracy’, which stated; “Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of healthcare in Britain” and that the NHS was “no longer relevant in the 21st century”, although he has since distanced himself from the book’s vision.

Hunt adopted three key strategies to ensure that the NHS wasn’t his career graveyard, as it had been for many Tory predecessors: hiding, hiding, hiding the figures, and (most of all) hiding behind someone else. His biggest talent is also, in fact, Boris Johnson’s: ducking accountability. The strategies are somewhat different, of course. Johnson’s bluster makes you suspect you’ve been had (but it appears that Britain, or at least the Tory part of it, includes a lot of masochists who rather enjoy that). Hunt’s smoothness means you don’t even notice. And the success of these tactics tells us much about technocratic attitudes to democracy, accountability, leadership and so-called public service ‘reform’.

Hunt’s complaints about Johnson refusing to debate him rang hollow to those of us who have followed him closely. Hunt is famous for dodging debates, whether with junior doctors, angry hospital users, in parliament or on the ‘Today’ programme, on which Hunt was a regular no-show during NHS crises. Where he did appear, he often restricted his appearances to issues over which he had no actual control, such as promoting a sugar tax. In fact, he became so notorious for shirking debate that hospital campaigners launched a “Hunt the Hunt” campaign, and junior doctors camped out on his departmental doorstep.

Blaming the patients

Hunt had no end of people that he (and his media cheerleaders) could blame for the problems besetting the NHS.

First off, patients. Be they old people, for being too old (“a challenge more serious than global warming”, Hunt said, even though this narrative doesn’t actually reflect the reality that health needs are highest in your last years of life, whenever that comes). It is true that health needs are rising among the poorest – and health inequalities increasing sharply – but blaming austerity policies and inequality for rising health demand wouldn’t have endeared Hunt to anyone in the Tory party. Instead, he relied on the ‘ageing population’ line routinely, when pressed on failures to meet NHS targets – such as an interview with the BBC’s Laura Kuenssberg, where he said, “the targets you talked about are because of the pressures of an ageing population”.

To add insult to injury, under Hunt’s tenure, the dehumanising labelling of old people as “bed blockers” returned, even as he did nothing serious to solve the issues of social care. Then there were children – and parents – blamed for being too fat, even as public health funding to address such issues was slashed. And smokers, who, along with overweight people, started to be banned from routine surgery under Hunt’s watch. Such patient-blaming decimated the NHS’s core values of universalism and comprehensive care, to the horror of doctors and nurses.

Devon’s 2014 attempt to ban smokers and obese people from all routine operations, regardless of clinical recommendations, generated a huge backlash. But in the next couple of years, Clinical Commissioning Groups (the NHS organisations that allocate local health funding) followed suit, with consultations geared towards removing certain types of services, in particular from the ‘undeserving’. A number of areas have now implemented these policies.

I asked Hunt about this at an Institute for Government event not long before he left office. He told me blandly that, “this shouldn’t be happening”. But there was no sign of him taking any action to stop what he routinely blamed on ‘local decisions’ (as we’ll see again with rationing of care).

Always top of the scapegoat list, of course, are migrants. From 2013 onwards, Hunt’s department worked closely with the Home Office on a string of initiatives to impose the ‘hostile environment’ (a policy which the former head of the NHS described as a “national scandal”). That led to cases like Albert Thompson, the Windrush victim who was denied cancer care. Hunt went pretty unscathed when these scandals finally broke through into the public consciousness, and these restrictions are still largely in place – along with the upfront charging systems now set up in hospitals, which many have observed could now easily be rolled out to others.

Blaming the staff

Blaming the staff is, of course, another favoured tactic of politicians, and one that Hunt embraced wholeheartedly (though he would no doubt like to think of it as ‘delegation’).

In terms of senior staff, in 2013, Hunt hired his Oxford contemporary, Simon Stevens, as chief executive of the NHS. Stevens quickly adopted the role of media frontman whenever the going got tough.

In hiding behind Stevens, Hunt benefitted from the post-2012 legal framing of the NHS as a standalone organisation (or rather, a tangle of competing, squabbling standalone organisations), given its money and left to get on with it. When problems arose, it was down to ‘the NHS’s own plan’, and ‘local decisions’. No longer did the secretary of state have a duty to provide or secure healthcare for us all.

Hunt got away with these tactics to a surprising degree, because the 2012 Health and Social Care Act that he inherited was poorly understood by journalists (and had been poorly explained by a Labour opposition then keen to hide its own Blair-era role in laying the groundwork). The Act was a nonsensical, destructive muddle, partly as a result of coalition compromises, so the implementation was critical – and the content and tone of that was down to Hunt. His first move was to add in the secondary legislation that gave the act its full privatisating force – including the Section 75 privatisation regulations that more or less forced local commissioners to offer any changes to local provision, out to tender.

But on the whole, Hunt outsourced strategic policy thinking (and ‘heavy lifting’ to shift public attitudes on charging, privatisation and hospital closures) to costly and wasteful management consultants including the Big Four accountancy firms (despite promising to rein in this spending), not to mention a collection of sirs, lords and commissions, regulators, right-wing think tanks, and in-house consultants dubbed “ninja privatisers” who were responsible for numerous expensive failures. (To be fair to Hunt, quite a bit of this policy outsourcing strategy was developed by his health secretary predecessors, both Tory and Labour).

As a result of the 2012 Act, Hunt had just one last bit of legal and parliamentary accountability for the NHS – the “mandate”, which required him to put the NHS’s annual objectives before parliament. But in 2015, when the scope of the mandate was being revised for the next five years, his department issued a public consultation that Hunt somehow failed to actually tell anyone about (it wasn’t even published on their departmental consultation page) – a ruse that caused something of a backlash after OurNHS got wind of it, particularly given the hints about widespread withdrawal of treatment.

While senior staff and outsourced policymakers were convenient stooges, frontline staff became Hunt’s favourite whipping boy. He kicked off his tenure by telling parliament that “cruelty became normal in our NHS and no one noticed”, implying that the criticisms of the terrible Mid-Staffs scandal were normal for the million plus NHS workers.

Blaming staff – and roping in the media to help – was pretty bad form seeing as their goodwill (including ‘donating’ £1.5bn a year in unpaid overtime) was the only thing keeping the show on the road during the post-2010 squeeze on NHS funds and staff pay. In October 2014, 450,000 NHS staff walked out in the first strike by health workers in 32 years.

But all this was just a foretaste of what was to come for doctors, nurses and other health workers.

In 2015, Hunt and Cameron promised a “seven-day NHS”, but Hunt was condemned in May 2016 by parliament’s Public Accounts Committee, which deemed the plan “completely uncosted” and said that Hunt’s department had made “no coherent attempt” to address the staffing impact of this pledge.

Instead, the burden fell on junior doctors, upon whom Hunt attempted to impose a contract to work more anti-social hours. The first junior doctor strikes in 40 years took place in response in 2016, and forced Hunt back to the negotiating table. But Hunt went on to impose the contract despite another ballot with a clear rejection of the deal.

After the junior doctors’ strike, in 2017, nurses threatened to strike for the first time in history. Hunt saw the strike off by promising what appeared to be a relatively generous offer of 3% rise for everyone. But days after he finally left office in July 2018, OurNHS uncovered how staff had had the wool pulled over their eyes and many were getting much less than they’d thought or been led to believe. Nurses were outraged and the head of the Royal College of Nursing had to resign over her role in selling the deal.

Although Hunt liked to portray his victory over junior doctors as boding well for any potential negotiation with the EU, the legacy of that dispute (and his management of the NHS’s workforce in general) was in fact one of enormous ill will and brain drain, with frontline doctors and nurses leaving the NHS at alarming rates. Nursing had a record vacancy rate of 41,722 nurses (11.8% of the entire nursing workforce) the month before Hunt departed. While Brexit was a factor, there was also huge demoralisation among NHS staff aware that they were struggling to provide safe care for patients. Meanwhile, Hunt scrapped the nurses’ training bursary, which resulted in applications to study nursing dropping two years in a row.

Perhaps what aggravated and demoralised doctors and nurses more than anything else, was Hunt’s audacious use of tactical shroud-waving. Previous Tory health ministers frequently accused their opponents of using deaths to make political points. But Hunt repurposed this trick against his opponents, veering close to accusing anyone standing in his way of being responsible for “avoidable deaths”.

Announcing his intention to impose a new contract on doctors, Hunt claimed that “around 6,000 people lose their lives every year because we do not have a proper seven-day service in hospitals… No one could possibly say that this was a system built around the needs of patients – and yet when I pointed this out to the BMA they told me to ‘get real.’ I simply say to the doctors’ union that I can give them 6,000 reasons why they, not I, need to ‘get real’.”

Experts took apart Hunt’s claims, showing that his use of weekend mortality data was “a shambles”. Hunt’s suggestion that the BMA was “turning medicine into a Monday to Friday profession” alienated the doctors who provide 24/7 emergency care (check out #ImInWorkJeremy), and he was even accused by doctors of having put at least 14 patients at risk by incorrectly implying that 24/7 emergency care wasn’t available.

Margaret McCartney, a GP, author and broadcaster, told me: “It’s dangerous to keep on misrepresenting data even when experts have told you that you are making a mistake… Hunt’s claim about weekend deaths, used to justify changes to the junior doctor contracts, has been debunked (patients admitted at the weekend tend to be sicker).”

The shroud-waving was a tactic he had already deployed effectively against his first parliamentary opponent, Andy Burnham, and indeed against interviewers. Questions about failures to meet targets on waiting times, when not being excused by the “ageing population”, were often met with impassioned statements about patients failed by the NHS in Mid Staffs, Morecombe Bay, Gosport and elsewhere – a strategy he also deployed consistently in media interviews (such as his interview with the BBC’s Laura Kuenssberg, when he was challenged on LBC by an angry doctor in the same week).

He had deployed the tactic too, against Lewisham campaigners, when his administrator’s report suggested closing the hospital and related changes would “save around 100 lives a year”.

Indeed Hunt has made the “patients’ champion” persona his own. He told the New Statesman that he had made patient safety his “life’s mission” and that when he left frontline politics; “I want to write a book on patient safety. I would like to do for patient safety what Al Gore has done for climate change…”

In reality, having wielded the Francis report into the Mid Staffs scandal as a weapon from the get-go, he junked most of its key recommendations.

Having promised in 2013 to bring in minimum standards of safety for ratios of nurses to patients, two years later he and Simon Stevens quietly tore these promises up as too “mechanistic”, to the concern of the report’s author, Robert Francis. Hunt’s repeated promise to put the patient at the centre of everything that the NHS did, including in its constitution (another Francis report recommendation) was similarly junked a year after its headline-garnering work was done. Promises to protect whistleblowers resulted in just another toothless system. Moves towards openness were undermined by increased reliance on the market and private sector provision, with nothing done to address the destructive ethos of competition between and even within hospitals that Francis had identified as a key part of the problem at Mid Staffs.

Phil Hammond, the doctor and broadcaster who has written extensively on patient safety, told me: “Hunt developed a selective interest in some aspects of patient safety… so although he will be able to cherry-pick to make it look as if some aspects of safety got better…. Hunt repeatedly refused to introduce mandatory safe staffing levels… There are of course some brilliant NHS staff who are very dedicated to safety, who have improved the situation in their particular hospital or GP practice, but I don’t really see how Hunt can take credit for that. Finally, despite his strong words about no more cover-ups in the NHS and better support for NHS whistleblowers, many of them say the situation hasn’t improved and they are still not being listened to and are being persecuted.”

So much for Hunt’s “patients’ champion” persona.

And of course, much else that happened to the NHS under his watch wasn’t very good for patients, either – in terms of safety, but also access to healthcare, privatisation and rationing. And this is where the last of his strategies came in very useful.

Playing with the figures

Part of Hunt’s pitch is that he is “on top of the detail”. In reality, he has worked to make it harder or impossible for the rest of us to check-up on the detail. Once A&E waiting targets were routinely being missed, he simply stopped publishing weekly data on the failures and dropped hints that the target would soon be dropped. Similarly, in response to regularly missing the target on maximum 18-week waiting times for planned operations, that target was quietly dropped. In response to alarming headlines regarding the rising number of hospitals declaring ‘black alert’ (unable to guarantee life-saving emergency care, and having to divert patients elsewhere), the ‘solution’ was to ban hospitals from using the term ‘black alert’.

In June 2017, Hunt was summoned to the Commons to answer questions about whether he had sought to cover up a damning report that found a private contractor had failed to process over 700,000 pieces of medical correspondence, a scandal that reportedly may have harmed the health of at least 1,788 patients and has cost at least £6.6m. A year later he was criticised by charities for waiting up to four months to tell the public about another error that meant 450,000 women hadn’t received breast screening invitations and – as Hunt admitted in parliament – 270 may have died as a result.

Under Hunt, the Department of Health routinely refused to answer parliamentary questions and Freedom of Information requests about which private companies the NHS’s money was going to on the basis that they didn’t centrally collate it. And it was also reluctant to release raw, uncollated spending data, being the last department to do so and only giving in after a petition to release it. Inconveniently timed information on the financial crisis engulfing hospitals was tucked away from view too.

In terms of money, in 2015, the UK Statistics Authority told Hunt to stop saying NHS spending was up, and a year later a committee of MPs found he had misled them on this point and he admitted he had played with the time periods.

And what of Hunt’s defining claim in the leadership campaign – that he was “the person who secured a historic funding boost for the NHS” just before leaving office in July 2018? While Hunt claimed that the deal was “one of the single biggest increases in funding for a public service in our history”, numerous experts pointed out that most NHS increases were generally “the biggest yet” (due to inflation), that this increase (at most, 3.4% a year) didn’t match the level of actual health inflation and higher need, and hadn’t made up for the shortfall in funding in preceding years. In the words of the National Audit Office, the funding boost was “inadequate” and left the NHS “unsustainable”.

Also worrying, it turns out (in the long term plan) that Hunt’s deal was conditional on the NHS achieving significant savings through the use of technology (something that many experts were dubious about), reducing face-to-face appointments by one third, and also on there being no additional pressures from the social care sector (that was on the verge on collapsing). And this 3.4% doesn’t apply to capital expenditure, staff training and pay, or public health budgets – all of which would remain up in the air until the next spending review. Theresa May promised the “Brexit dividend” would fund the increases. That didn’t quite pan out though, did it? As a Nuffield Trust health expert put it, “The NHS would be wise to hang onto the receipt for this particular birthday present.”

There are many more facts I could throw at you to help you see Hunt’s legacy. Public satisfaction with the NHS fell during Hunt’s time in office, for example. Both maternal deaths at childbirth and infant mortality started to worsen again towards the end of Hunt’s tenure, after decades of improvement. And one last statistic is perhaps the most damning. In an interview with the New Statesman, he quoted Stephen Pinker as saying that “life expectancy has gone up!”. While this is true globally, the story in Britain is different. Since 2015, projections for life expectancy in the UK have fallen by more than a year.

It tells you much about British politics that a man with Hunt’s record was promoted to foreign secretary, and after losing one leadership bid, again now stands a small chance of becoming prime minister. It tells us a huge amount about the state of the British press that Hunt is treated as a serious candidate.

And it’s worth remembering, that whoever succeeds Johnson will face the same advantages that Hunt has always had: an establishment that doesn’t care too much what happens to ordinary people’s services, so long as no one makes a fuss, and a pliant media, always ready to believe the spin of some old public schoolboy.

This article first appeared on openDemocracy and is reproduced here under  Creative Commons Attribution-NonCommercial 4.0 International licence