When will Jeremy Hunt stop skating and fall through the NHS ice?

Health secretary Jeremy Hunt moves quickly to condemn failure even if he is not in possession of all the facts, says Richard Vize. Photograph: Getty Images

So far, Jeremy Hunt has been skating over the NHS ice with the practised ease of an impressive communicator. When will he fall through?

In the wake of the Francis inquiry, the health secretary has shrewdly positioned himself as the patients' champion against the vested interests of the healthcare system. He moves quickly to condemn failure, even if, as in the case of the Care Quality Commission's recent convulsions over the Morecambe Bay maternity failures, he is not in possession of all the facts.

(The unravelling of the Grant Thornton report into the CQC's supposed cover-up means there is now the prospect of an investigation into the investigation into the investigation into the investigation. I can't help thinking there must be a better way of doing things.)

Hunt's announcement on the NHS's 65th anniversary that older patients should have a named clinician overseeing their care outside hospital was typical of his approach – being seen to be protecting the patient while riling the medical establishment, some of whom saw the move as interfering in the relationship between patients and GPs.

Ministerial simple ideas to improve care are rarely much help. Hunt's grand gesture was reminiscent of Gordon Brown's "deep clean", when he took personal charge of the country's hospital cleaner rotas by ordering a national frenzy of mopping and wiping in response to concerns about hospital-acquired infections. It wasn't the answer, but the public loved it.

Yet it wasn't supposed to be like this. Under the reforms, politicians were supposed to be removed from routine intervention in the running of the NHS, while the then NHS Commissioning Board was supposed to oversee the commissioning system. Now everyone has forgotten the script.

The board has, predictably, taken its name change to NHS England as a licence to interfere wherever it likes. Its plan, revealed in the Health Service Journal, to take control of investment spending, even where it has no formal powers, is just the latest evidence of how little has changed when it comes to central control.

Hunt, in turn, is being anything but hands off. He is insisting on weekly reports from NHS England chief executive Sir David Nicholson – an idea to which Nicholson has not warmed – and his influence can be seen in both actions and inactions.

A notable case of the latter is the Department of Health's repeated stalling on the development of a coherent approach to service reconfiguration. Hunt does not see his job as getting the health service right, but minimising the damage the NHS can do to the Conservatives' election chances.

For that reason, despite his admission that the involvement, under the government's reforms, of the Office of Fair Trading in decisions about trust mergers is causing problems, it is all but impossible to imagine him bringing forward legislation to sort the mess out. Laying bare a mistake in the government's approach to competition in the NHS would be a gift to Labour's election strategists.

But Hunt is overseeing a clutch of policies that cannot all be sustained – a funding freeze, pressure to integrate health and social care, a demand for round-the-clock consultant-led care and a refusal to face up to the need to merge and shut services. There simply cannot be round-the-clock high-quality care in all the existing hospitals at the same time as real-terms year-on-year funding cuts.

But with fewer than 100 weeks until polling day, the chances of Hunt providing the political leadership that is required to ensure the NHS enjoys many more anniversaries is remote. The time for this to happen was, of course, the first few months of the new government, when there was the prospect of ministers having enough time to see some of the benefits of bold decisions coming through.

So Hunt will keep skating, keep playing the patient champion and keep avoiding the hole that is gradually opening up at the core of the health service. It will be for his successor to take the plunge.

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