Why is Jeremy Hunt so determined to hang on at the Department of Health? He faced down Theresa May during her reshuffle last month and it seems likely that he did the same after the general election last year, when he was also widely tipped to be moved.
Hunt’s tenacity suggests he believes that he is doing a good job. That might seem unlikely, given that he presides over a service that is falling apart – at the cost of unmeasured lives lost and suffering prolonged, to say nothing of staff burnout and disillusion. But the idea makes sense if, for Hunt, doing a good job means something entirely different.
A clue lies in the 2005 policy publication, Direct Democracy: An Agenda for a New Model Party, which Hunt co-authored with a number of other Tory MPs. Part of the book outlines a blueprint for an insurance-based system to replace the NHS, stating, “Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of health care in Britain.”
The individual chapters of Direct Democracy are not attributed to named authors, and Hunt has latterly distanced himself from the vision the book portrays. But perhaps this is an occasion where Mandy Rice-Davies’s famous rejoinder, “Well he would, wouldn’t he?” applies.
It is received wisdom that no serious political party would dare overtly to declare an intention to dismantle the NHS. Such wholesale change could only be presented as a reluctant response to a self-evident failure of the existing system. The austerity agenda has been seized by the Tories as the fig leaf behind which to progressively underfund health and social care, creating today’s crisis.
Now that the system has been brought to failing point, how does the goal of denationalising the NHS become reality? There has been creeping privatisation of health care since the Blair-Brown era (though in fairness, New Labour intended to strengthen, not do away with the NHS). However, the contracts won by private companies to date have been relatively small beer: a few million here and there.
In April, though, Hunt aims to establish the first accountable care organisations (ACOs). ACOs will hold multibillion-pound budgets to deliver combined health and social care for large geographical areas. There is much merit in merging services like this, but the way Hunt intends to set up ACOs will open them to competitive tender, with opaque lines of responsibility once contracts are awarded. This is exactly what the huge private health care companies have been waiting for – the chance to take over whole chunks of the NHS and social care sectors and run them on commercial lines.
It must feel to Hunt as though the ambition articulated in Direct Democracy is tantalisingly within his grasp. He must fear that any new incumbent at the DoH would lack the resolve to see it though. This is a rare moment: the chance finally and irrevocably to change the way British health care is delivered. It may well be lost were he to go.
Perhaps that is how he persuaded May to keep him in the post. Yet there are still hurdles to clear. One is the health select committee, chaired by Tory MP and former GP, Sarah Wollaston, who has written publicly to Hunt calling for a halt to ACO implementation pending an enquiry. Another is the crowd-funded application for judicial review launched by eminent doctors and academics, including Professor Stephen Hawking. They argue that Hunt does not have the power to push through such radical changes using only secondary legislation, which would not attract due parliamentary scrutiny.
The combined pressure has already forced the hurried announcement last week of a belated, three-month public consultation on ACOs. One can only hope the “direct democracy” of these defenders of the NHS will ultimately be the version that prevails.
This article appears in the 31 Jan 2018 issue of the New Statesman, The Great Migration