What will Jeremy Hunt as chancellor mean for the NHS?

Hunt appears to have undergone something of a ‘road to Damascus’ experience since his stint as health secretary, writes Ian Hamilton

Of all the positions in cabinet, health secretary is the one most aspiring politicians view as the least attractive. The NHS is sacred, and yet there is never enough money to meet the burgeoning health needs of the nation.

Not only was Jeremy Hunt, the newly appointed chancellor, previously the health secretary, but he held the post for longer than any of his predecessors. You don’t expect to be popular as health secretary, which is just as well, but Hunt has a record of taking on significant challenges during his term at health.

He made it his mission to focus on safety, prompted by the inquiry into the lack of care at the Mid Staffordshire NHS Trust. He recognised that there was a culture of covering up mistakes, and sought to foster a learning and no-blame culture in the NHS. Many current staff in the health service will have a view about whether he managed to achieve this or not.

Hunt appears to have undergone something of a “road to Damascus” experience since his stint as health secretary. At the time, he was critical of primary care and of GPs in particular, but he now apparently recognises the need to remove some of the burden of bureaucracy that adds very little to quality of care, such as the Quality and Outcomes Framework, referred to as the QOF.

Hunt did little to push for a long-term workforce plan as health secretary, but this could change now he is chancellor. The fear had been that creating a workforce plan would tie the Treasury into committing funds for years in order to ensure that there were sufficient doctors and nurses in training to meet the future needs of the NHS. If he does do this, it would represent the single most important move for the NHS in decades.

No other organisation of this size limps from year to year without a plan to recruit its workforce. The absence of a plan has been costly, and has sapped the morale of current staff, who are left to make the best of what they have in under-resourced hospital wards and community teams.

The only other matter as momentous as that of a workforce plan is the question of how, as chancellor, he tackles the newly integrated health and social care systems. Hunt knows how fiendishly difficult and expensive this challenge is. The population is ageing and medicine is advancing, but overall life expectancy has stalled. Tackling this requires eye-watering amounts of money if we are to provide services that are timely and humane.

As health secretary, he is reported to have insisted that he take on the brief of both health and social care, and that’s to his credit. It remains to be seen whether he can use this enthusiasm to make a meaningful difference to the logjam that exists in hospitals, of people who are well enough to be discharged but don’t have the appropriate facility or care package in place to leave.

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As it stands, we rely on a legion of unpaid carers to fill the gap, but they are ageing fast, and as result, developing their own health and social care needs. Their voluntary work is not finite, and he knows that.

Some of the funding needed to integrate health and social care effectively, as well as publish a workforce plan, was in place. However, Hunt’s short-lived predecessor, Kwasi Kwarteng, announced that the rise in national insurance is to be cancelled.

Be under no illusion: Hunt won’t just be looking at other departments for “efficiencies” – the politically palatable phrase for savings. He will be looking at health and social care too, and there will be a drive towards core services, which will leave some so-called peripheral services struggling or wiped out completely. These are likely to be specialities, not limited to but including drug and alcohol services, some niche mental health services, and sexual health and gender reassignment.

Don’t expect “compassionate conservatism” to be evident in Hunt’s approach to health and social care. It’s unlikely that he thinks he can afford it – even if it’s what we, and the NHS, really need.