Could 'good egg' Jeremy Hunt be the saviour of the NHS?

'I have come to the conclusion that health secretary, Jeremy Hunt, is a good egg', writes Dick Vinegar. Photograph: Linda Nylind for the Guardian

I have come to the conclusion that the health secretary, Jeremy Hunt, is a good egg. As a long-term NHS customer, he does seem to think like a patient. What's more, he has two of the same bees buzzing in his bonnet as I have: that GPs should take back oversight of out-of-hours care, and that the lack of effective IT in the NHS is a disgrace.

But, first, there are his visits to GP surgeries and hospital wards. These are not just lordly ministerial visits. He gets down to the nitty gritty of prescribing the exact amount of medication for a diabetic patient. He gets the bad news about the stresses of doctors' lives. He was told first hand how GPs resent having to ask all patients irrelevant questions laid down by the Department of Health. It is not only Hunt himself who visits the sharp end. He gets his mandarins to spend four weeks a year on the front line, emptying bedpans if required.

This is wholly revolutionary, aimed at reducing the gap between Whitehall civil servants and the nurses on the wards. No other minister has ever done this.

This does not make the doctors like him any better. In fact, I have a sneaking suspicion that they think he has no business on the wards, and he might get to know too much and find the skeletons in their cupboards. Hence their hostility, which resulted in the BMA giving him a vote of no confidence at a recent LMC conference. Hunt, in an interview in The House Magazine, wryly points out that the BMA also passed votes of no confidence in Patricia Hewitt, Alan Milburn and Andrew Lansley. "I am afraid I am not alone in the club." He also got a lot of stick from GPs for having the temerity to ask for the return of the responsibility of out-of-hours service to GPs. I suspect that, rather like me, he was shocked to find that in 2004, the GPs had traded that responsibility for gold, £6,000 to be precise.

Thereby, they gave up the GPs' historic 24/7 care for their patients, on which we, the patients, in an ever more confusing healthcare world, absolutely rely.

Jeremy Hunt grumbled that because patients would not know their out-of-hours doctors, they would opt to go to A&E instead. I have anecdotal evidence from my contemporaries, that this happens. But the doctors chose to respond that Hunt was carrying out a personal vendetta against them, and blaming them for the long waits in A&E.

A survey by Pulse found that 85.6% of GPs said they would not take back responsibility for out-of-hours care and 61.9% would take industrial action if forced to do so.

When, on 11 June, I, like Jeremy Hunt, called for a return to the continuity of care that I had been used to before 2004, I got a lot of abuse (and a few courteous replies) from doctors, like "uninformed dross" and "ignoramus", despite the fact that I was saying that I love my GP practice so much that I want them to be responsible for me 24/7.

I am glad that since the end of June, attitudes seem to be changing. Many doctors have come out of the woodwork, who have been providing out-of-hours services in one form or another for years. I have even seen claims that 40% of out-of-hours work is currently provided by GPs.

I get the feeling that in the last week or so, doctors generally are beginning to realise that I and Jeremy Hunt may be right, however noisily their leaders may huff and puff. Some seem secretly rather chuffed that patients like me value their 24/7 service so highly, and are devising ways of making a return to the old ways possible. I believe that Hunt's challenge has been largely responsible for this change of heart. Hunt is indeed a good egg.

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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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