Andy Cowper: From Hunt to Hancock—a changing of the guard

Jeremy Hunt’s promotion to become the new Foreign Secretary (in the wake of the latest Brexit brouhaha) means that he joins the select club of Alan Johnson and Kenneth Clarke of those who go on from the health brief to occupy one of the UK’s four great offices of state.

Hunt became the UK’s longest-serving health secretary ever earlier this year. That was an impressive feat. Health has a well-earned reputation as a graveyard of Cabinet political careers.

How did he manage that? Does Hunt have a legacy? Is there a Huntism?

Hunt was given a fair wind coming in to the health brief in September 2012 by the sheer political controversy and unpopularity of the competition-oriented reforms that his predecessor in the job Andrew Lansley had managed to get through the Coalition Government in the 2012 Health and Social Care Act.

Hunt was helped by being a clear and increasingly confident public speaker, and by the lack of envy of the health job among his Cabinet colleagues. David Cameron re-appointed Mr Hunt after the Conservative Party won an unexpected overall majority after the 2015 general election (and as the last confirmed appointment). Hunt was then reaffirmed in the role twice by Theresa May—on the most recent occasion, persuading the PM not only to leave him in post, but to add the social care portfolio to his job and his department’s name.

That is not enough to explain Mr Hunt’s longevity, however. His political opponents—initially Andy Burnham, then Heidi Alexander, Diane Abbott, and Jonathan Ashworth tended to underestimate him, which helped. The Lansley reforms effectively ceded the health secretary’s explicit overall control of the NHS with the creation of autonomous NHS Commissioning Board and an increase in the remit and influence of the foundation trust accreditor and regulator Monitor, which was turned into a competition regulator for the NHS. This made it more difficult for the opposition to pin blame on Hunt individually. The Labour Party’s incessant and inaccurate protests that the Lansley reforms were privatising the NHS did not make it easier for their criticism of Hunt to stick.

Patient safety has been a key theme of Hunt’s time in the job. He arrived just in time for the Mid Staffordshire Public Inquiry report by Robert Francis, which is said to have shocked him deeply. One of the consequences of this was the transformation of the Healthcare Commission into the Care Quality Commission, a rather more activist regulator and investigator of healthcare providers.

The consequence of his awakened interest in patient safety was, positively, a consistent focus on the issue and willingness to learn from international good practice. Mr Hunt also repeatedly held meetings with people who had been victims of poor care in the NHS.

Less positively, the early stage of Hunt’s time was a highly activist approach to providers who were having problems with quality or finances. Despite the Lansley legislation promising to limit the Health Secretary’s powers to intervene, Hunt’s Monday mornings were a mixture of phone calls to the chief executives of these troubled trusts to increase pressure for action (often at undeliverable speed), and hardy system performance management meetings.

The corollary of this approach was that many NHS staff increased the regulatory burden: the system seemed to believe that only by regulation could another Mid-Staffs be prevented.

Over time, Hunt came to accept that greater transparency, openness, and human factors thinking about the safety design of systems would be vital to change the culture of the NHS from one where mistakes were feared and covered up to one in which the learning from incidents or near-misses would positively drive improvement. The NHS still has much further to go on this, but some positive progress has been made and the problem is better-acknowledged that previously.

Money has been a constant issue, with the NHS seeing funding increases well below the long-run average of 3.7% real terms growth throughout this decade. The consequences have been predictable, with widespread financial trickery, growing waiting lists and times and the vast majority of NHS commissioners and providers ending up in deficit, and some borrowing from the Department of Health at 6% interest.

Hunt was slow to realise that NHS deficits were driven by the funding being lower than the costs of production of the care required. When the funding settlement for the Five-Year Forward View was announced, Mr Hunt unhelpfully backed then-Chancellor George Osborne’s incorrect assertion that the NHS “had been given £10 billion extra.” In reality, cuts to central education and public health budgets meant that the actual real-terms increase was just over £3 billion.

Since early 2015, however, Hunt has been clear in private (and latterly in public, as Cabinet collective responsibility frayed to breaking point) that a significant boost to NHS funding would be required. His part in delivering the recent settlement was significant. After some stormy periods (including quite recently), Hunt and NHS Commissioning Board boss Simon Stevens developed an effective détente and way of working together.

Less positively, the dispute with the junior doctors (fuelled by his inaccurate comments about seven-day working) showed that Hunt’s determination can spill over into stubbornness. However, the handling of the dispute by the BMA, exposed by a leak of WhatsApp messages, made many observers wonder if both sides couldn’t perhaps lose? To some extent, they did both lose: Hunt cost himself the benefit of the doubt with many NHS clinicians, and the BMA is now damaged as a political force.

Technology was another enthusiasm of Hunt’s. He has been an increasingly keen and proactive, and at times robust, user of Twitter throughout his time at health: it will be interesting to see whether this is sustained in the field of international diplomacy at a time of Brexit. The ambition for the NHS to be paperless by 2020 was quietly slipped to 2022, but greater transparency and technology has been a constant of Hunt’s bigger set-piece speeches.

Less is easily known about his successor, MP for West Suffolk and former culture, media, and sport secretary Matt Hancock. His voting record can be seen here.

A former Treasury economist and junior Treasury minister under ex-Chancellor George Osborne, he can reasonably be expected to start out economically dry and sceptical of the NHS begging bowl. His success during a short time on Parliament suggests that Hancock will be a broadly socially liberal, fiscally conservative minister of the “Camborne” (Cameron-Osborne) persuasion.

Hancock is known to favour digital technology, having attracted some comment when he launched his own app about himself as an MP. Here there is sure to be continuity. Political commentators note that Hancock is a game sort, which will be useful in his new role.

Hancock will have to wrestle with a likely winter crisis within months (as the new money won by Hunt does not start until the 2019-20 financial year). He will be confronted by the ongoing non-solution of social care, and the article he wrote in 2012 suggesting that private insurance should be used to this end will get close scrutiny.

He also faces the decision how to interact with Simon Stevens’ latest “next ten years” vision/plan/provocation about how the NHS will use its extra funding, while he will still be relatively new to the brief.

The decisive feature of Hancock’s tenure in the role could of course be its concise nature: the Parliamentary Conservative Party is profoundly and unmistakably fissured from top to bottom over Brexit. Were it not for Jeremy Corbyn’s “Trotskyist Magic Grandpa” (“Magic Grandpa” phrase coined by David Paxton) leadership of the Labour Party, May’s administration would be in even more profound trouble than it already is. The future isn’t what it used to be, for Hancock, or almost anyone else in UK politics.

Andy Cowper is a freelance journalist and contributing editor of and columnist for Health Service Journal.

Competing interests: None declared.