At noon on Mondays, Jeremy Hunt’s workplace on the fourth floor of the Department of Health’s Whitehall headquarters fills up. Usually hosted by the wellness secretary himself, the midday meeting focuses on what the division calls “NHS delivery” – that is, how the NHS is carrying out its vital position.
There are typically 25-thirty in Hunt’s area, with a few obtaining to stand because there is not ample area around the table. Top brass from the 3 important NHS bodies charged with overseeing the overall health support are usually current. There’s also one or more of Hunt’s ministerial crew: Earl Howe is a normal whilst Norman Lamb and Dr Daniel Poulter are semi-regulars, along with Hunt’s permanent secretary, Una O’Brien, and often the prime minister’s health adviser, Nick Seddon.
People meetings started shortly following Hunt was appointed in September 2012 and have taken place practically every week since.
But final October, amid gathering fears that the impending winter would be quite hard for the NHS, he instituted a second standard weekly meeting in his office, on Thursday afternoons, which looks at how the service is coping.
Fewer individuals attend the Thursday gathering, however the three crucial organisations – the department’s arm’s-length bodies (ALBs) – constantly do. They are NHS England Check, which regulates semi-independent foundation trust (FTs) hospitals and the Believe in Growth Authority (TDA), an arm of the wellness department that seems following non-FTs. Civil servants jokingly refer to it as “the meeting of the 3 Davids” due to the fact the 3 bodies are headed by, respectively, David Nicholson (despite the fact that he measures down at the finish of March to be replaced by Simon Stevens), David Bennett and David Flory.
These meetings are unusual – without a doubt, unprecedented – and controversial. Till now, their existence had not been reported, nor the concern and annoyance that senior NHS figures truly feel about them. Some of them see them as evidence of Hunt’s “handle freakery” and an chance for him to contact the organisations collectively to give them their “orders” for the week.
Such is the health secretary’s modus operandi that Professor Chris Ham, chief executive of the King’s Fund overall health thinktank, says: “Effectively Jeremy Hunt has become the executive chairman of the NHS.”
Hunt can seek out a in depth report into one hospital’s failing finances, inquire to be briefed on the planned reorganisation of hospital providers someplace in England – the likely political fallout from the rundown of any hospital so shut to the election is a priority –or demand enhancements in a hospital’s A&E overall performance if it is not treating the required 95% of patients inside of four hrs.
There is widespread concern at senior ranges of the NHS that Hunt’s tendency to routinely inquire the bosses of the ALBs to look into issues, take action and then report back on progress will take up considerably of their week and amounts to unjustified direction and interference in their operate. There is an “understated risk in his technique”, according to a single NHS insider.
“He’s tasking the individuals who turn up really challenging,” said another senior NHS source.
“You are tied up for many hours soon after that, especially in creating details on issues he has asked about,” explained yet another, who lamented the “market of data Hunt has produced, going backwards and forwards in between the DH and the ALBs”. No wonder, as a senior supply mentioned, “the bosses who go really feel leaned on”.
An ally of Hunt admits that “Jeremy is really directing at these meetings with the NHS leaders – considerably a lot more hands-on than Andrew Lansley. He identifies a issue, agrees with them a way of dealing with it and then comes back to them a week or two later on to examine if what was agreed has in fact been done.”
No preceding health secretary has held such management meetings. But then, Hunt only demands to hold them simply because his personal government’s radical restructuring of the NHS in England last yr dispersed power between a clutch of mostly new bodies, each and every accountable for specified factors, leaving – in concept – no a single individual or physique in all round management.
Till final 12 months, that individual was the NHS chief executive, who did his or her best to help hold the service on-track for whoever took place to be the well being secretary at the time. Nicholson served five in his eight many years. The overall health secretary was responsible to parliament, but the NHS chief executive utilised his or her command and manage to make factors take place.
Factors are much more complicated now. The highly contentious Overall health and Social Care Act was meant to make great coalition guarantees to set up an independent board to run the NHS in England – NHS England – and allow it get on with the task of working the services, albeit within parameters set by ministers. On 1 April 2013 Nicholson and other senior civil servants ceased working for the DH and transferred to NHS England, which will get its £95.6bn price range from the DH.
The coalition agreement of May 2010 explained that “we want to free NHS workers from political micromanagement”. The then overall health secretary Andrew Lansley’s NHS reform white paper two months later, subtitled “Liberating the NHS”, pledged that the new independent NHS board would be “cost-free from day-to-day political interference” and that the legislation would “limit the capability of the secretary of state to micromanage and intervene”.
Even though Lansley believed all that, Hunt seems to feel otherwise. “He’s controlling the NHS by controlling all of the important NHS bodies, and controlling the NHS practically in spite of the legislation,” said a single of the NHS’s most experienced powerbrokers.
Professor Ham says Hunt is responding to the fact that Amount Ten and the Treasury are really interested in its functionality, each clinically and financially in the run up the election. Nevertheless, he adds: “Senior NHS leaders have expressed worries about Jeremy Hunt’s extremely shut involvement in the working of the NHS.”
One NHS insider stated: “Hunt has completely reversed Lansley’s philosophy that troubles in the NHS had been nothing at all to do with him or with politics. Instigating the Thursday meetings showed he wished to do every thing he could to steer clear of a crisis. His method is, ‘if there is a difficulty in the NHS, we get in there and kind it out’.”
The outgoing Nicholson’s second ever tweet, when he ultimately joined Twitter on thirty January, was an in-joke to fellow NHS leaders. Responding to a spoof tweeter known as Jeremy_Twunt, he wrote: “Hello, Jeremy. Any guidelines for the weekend?” Following initially attending the Monday meeting some weeks, Nicholson declined to proceed. His deputy, Dame Barbara Hakin, usually goes alternatively.
Well-placed NHS sources say that she is the one particular among the senior regular attenders who enjoys pursuing Hunt’s issues. “Barbara loves it. She has no difficulty with currently being tasked. She loves to see herself as Hunt’s right-hand female – his deliverer.”
Unusually, even though notes are taken at these meetings, no minutes are created or circulated. Nevertheless, a series of “action points” – particular duties the ALBs must now pursue – are agreed as an alternative.
Hunt’s highly interventionist type has produced resentment and led to rows. “There was a sense that this was direct operational interference by the secretary of state in the operational management of the NHS, which is unprecedented,” said 1 senior source.