For a cabinet minister, party conferences are a major chance to shine. The preferred role is as a striker—a zealous reformer with an eye-catching administration-defining programme. Next comes the midfielder—the safe pair of hands making steady progress. Finally, the embattled goalkeeper—the able last defence against attack in difficult policy terrain. At next week’s Conservative Party conference, what role will Secretary of State for Health Jeremy Hunt play?
The context is difficult. There isn’t money to do much new: in a decade of the most austere funding growth since the NHS began, next year the pinch is hardest. The legislative schedule will be full of Brexit-related activity. Following the unpopular Health & Social Care Act 2012, there is no stomach for more upheaval in the NHS in England, and given the parliamentary maths not much scope for it either. After what many saw as a damaging own goal for Hunt in the match with the junior doctors over seven day working two years ago, he will be wary of any replay with new opponents. Finally, the full strategy set out by the NHS itself in the Five Year Forward View means the room for new initiatives is limited.
And yet his in-tray is full of big issues, any one of which could fully detain him for the next year. Some clarity on these, or even an acknowledgement they are being worked on, will be important to hear in his upcoming conference speech.
Biggest of all relates to the NHS workforce. First, how to address shortages, in particular the number of nurses and GPs which fell over the last year. Gaps in rotas in A&E and the wards get headlines, but general practice and community services are being hit even harder. This is ironic when the thrust of the Five Year Forward View is to boost this type of care, in part to reduce avoidable dependency on hospitals. Second, how the government is seeking to at least retain the 5.5 per cent of the NHS workforce who are from the EU, and make sure the dots are joined with immigration policy to allow in skilled health workers from other countries. Third, the government’s approach to lifting the pay cap for NHS workers will also be important to clarify, given the workforce shortages and following pay increases for police and prison staff.
"The NHS has been living on borrowed time with mild winters over the last few years—but with 'killer' flu threatening from Australia the odds are shortening"Next and arguably more difficult is what progress is being made on social care, the lack of which is proving very expensive. This situation may upend the NHS this winter, and must be at the top of the government’s risk register. The spring 2017 budget document promised “substantial additional funding” and the Chancellor said that a green paper was “imminent.” The latest is that this is now in Damian Green’s in-tray but it’s all gone a bit quiet. Regardless of which minister is technically responsible, given the risks Hunt has to say something meaningful here.
Then there is winter. The NHS has been living on borrowed time with mild winters over the last few years. But with “killer” flu threatening from Australia the odds are shortening for a significant crisis. Apart from patients, other casualties of a bad winter may include some of the government’s iconic targets for the NHS, in particular the four hour maximum wait in A&E. But holding the NHS’s feet to the fire to achieve this A&E target, in the face of a big flu outbreak, as the government looks set to do, is completely unrealistic given the backdrop of the financial squeeze. Don’t expect Hunt to broach that, but he should reassure about the very significant work that is being done to boost resilience of the NHS given the threat.
Given the impending risks, he will want to remind conference of the progress he has made on patient safety, following the 2013 Francis Report into the scandal at Mid Staffordshire Hospital which has defined his tenure to date.
Finally, Hunt should say how his department is galvanising action across government on the factors that impact on the health of the population. These include poor housing, in-work poverty, flawed early years and youth services, and poor nutrition. No one is acting as steward for the health of the country, and he could and should show active leadership here.
All this points to Hunt wearing the midfield shirt for now. But at five years and counting, note he is still on the pitch.
