Taking the poison

15 Jun 07
VICTORIA MACDONALD | A story once did the rounds of the Whitehall corridors that outgoing health secretary John Reid took a possible successor to one side and said: ‘Don’t do it, I’ve spent all the money. From here on in, it is a poisoned chalice.’

A story once did the rounds of the Whitehall corridors that outgoing health secretary John Reid took a possible successor to one side and said: ‘Don’t do it, I’ve spent all the money. From here on in, it is a poisoned chalice.’

How much of a poisoned chalice current Health Secretary Patricia Hewitt has found the job, I do not suppose we will ever know. She always remains resolutely upbeat, even when all is not going to plan (see junior doctors) or the unfavourable headlines which greeted the ‘good news announcements’ such as waiting times or the NHS surplus.

Still, that is yesterday. Now there is tomorrow and few seem to think she will continue to be health secretary in Gordon Brown’s Cabinet. Which leaves the next person in the job facing what, exactly?

It is clear that the pain is not yet over, despite the vast improvements in the NHS over the past ten years. So the next health secretary will not only have some new tasks on his or her to-do list but also a fair degree of tidying up.

Right at the top of that list will be dealing with NHS staff. The British Medical Association last week accused Labour of bringing the health service to its knees with its budget cuts and claimed the government has lost the confidence of the entire medical profession.

It is the BMA’s annual conference season and there is a lot of politicking going on, but on the whole the medical profession is deeply angry with Hewitt and her team. This is not just the doctors but also the nurses and other staff, who feel they have been treated with disdain with no pay rises, or staged increases instead.

They also believe they have borne the brunt of the cuts imposed to return the NHS to surplus and that, as they have complained about maternity units being closed or junior doctors’ training budgets being plundered, they have been ignored.

However, at a recent Fabian Society lecture, health minister Andy Burnham said that the emphasis for the next decade will be on quality, not quantity, with care driven by empowered staff and the decisions of patients.

He also said it would be less about further structural change of NHS organisations, which will please many in the health service, and more about the emergence of new partnerships. The moment, he was saying, had come for primary care.

All of which chimes nicely with Brown, who has already signalled his intention to tackle out-of-hours and access to GPs, although without saying exactly what he is going to do.

The next health secretary will have to walk a fine line between keeping the family doctors onside (or getting them back there) and satisfying the legitimate public concern that we are not receiving the best primary care possible after 7pm.

But even before that, he or she will have to deal with the problem of the primary care trust deficits, which nobody seems to know how to handle.

Nor has NHS overspending gone away. There are still far too many trusts with seemingly intractable deficits, creating stark regional variations. Lucky for you if you live in Leicestershire and bad luck if you live in Cornwall.

This is against the background of the Comprehensive Spending Review negotiations, which are now believed to be over a matter of decimal points. Four per cent? Five per cent? Whatever it is, we know it is not going to be on a level with previous settlements. And that things are going to be very tight.

The NHS Confederation points out that the pay reform programme Agenda for Change alone has in-built automatic increments which will put pressure on the budget, as will the staged pay awards.

One thing the next health secretary is not likely to have to do is oversee a new, independent NHS. Brown did enthuse about it at last year’s Labour Party conference and much speculation was caused by the announcement of the new leadership team at the Department of Health, under the auspices of chief executive David Nicholson. But the idea has gone away, although it does remain on the shadow health secretary’s agenda.

Patient Choice? There seems to be an internal Labour Party debate about the value of pursuing this, with some asking just how much choice patients really want.

MRSA and other hospital superbugs? The Healthcare Commission is already planning spot checks but it is a vote winner for any politician to be seen to be tough on grime, tough on the causes of grime. And the figures are far too high.

Last but not least, the NHS IT system needs to be dealt with quickly before any more money is wasted.

Of course, one wit suggested that if you were a conspiracy theorist you would have Brown leaving Hewitt in place at the DoH so that it is she, instead of one of his favourites, who takes the flak for the hard times ahead. How devious would that be?

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