What can Jeremy Hunt learn from past health secretaries?

http://www.theguardian.com/healthcare-network/2015/jul/02/jeremy-hunt-learn-past-health-secretaries

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What do you learn from taking on the toughest job in government, secretary of state for health? At the Institute for Government three former secretaries – Conservative Stephen Dorrell and Labour’s Alan Milburn and Patricia Hewitt – shared their wisdom alongside incumbent Jeremy Hunt, who was apparently keen to learn from the wise words of his predecessors.

Co-hosted by the Health Foundation, it followed the publication of Glaziers and Window Breakers, interviews with 10 former secretaries of state, which was the first document Hunt found on his desk on returning to the Department of Health’s Richmond House headquarters after the election.

The fact that even the passing of decades has not diminished their fascination with the role says a great deal about the hold the post has over those who occupy it.

As Dorrell pointed out, there is nothing new that health secretaries have to deal with – a unique mix of policy and management. While the plan to devolve healthcare powers to Greater Manchester is portrayed as an innovation, 70 years ago Nye Bevan and Herbert Morrison were debating within the cabinet of Clement Attlee the tensions between local and national control of healthcare.

With a strong sense of history, Dorrell pointed out that it is replete with political ironies, such as Keith Joseph’s approach to the NHS being highly bureaucratic while Enoch Powell warmly embraced state planning.

In terms of advice for present and future secretaries, Milburn stressed the importance of not walking into the job with a fixed point of view – which, as he pointed out, was Andrew Lansley’s big mistake. But neither can you arrive at the Department of Health and simply try to guess the solutions to complex, decades-old problems.

There was unanimity that you cannot join services up from Whitehall, but you can provide incentives to promote change and encourage clinicians to have “divine discontent” in the consulting room. In other words, encourage a constant desire to get better at what they do.

It is also a job that requires a degree of humility; Dorrell stressed the folly of ministers trying to tell clinicians who had decided to dedicate their whole lives to healthcare that a here today, gone tomorrow politician knows best.

A curious aspect of being health secretary is that the incumbents are constantly trying to give power away, and the public keeps giving it back to them. As Milburn emphasised, no matter how hard a health secretary tries to move power out of Whitehall, legislation is trumped by the behaviour of politicians and the public. Hunt is the most striking example of this – his hands-on involvement in the detail of NHS management is contrary to one of the key tenets of Lansley’s reforms, which was to try to keep politicians at arm’s length.

But Hewitt identified one notable success from the Lansley “shambles”. The creation of the arm’s length commissioning board – now evolved into NHS England – has given the NHS a powerful, semi-independent voice that could act as a bulwark the next time a health secretary has a bad idea.

So what exactly is the job? The consensus seemed to be that it was about creating the conditions for change, promoting it and explaining it. Milburn argued that the NHS needed to embrace the old Trotskyist notion of “permanent revolution” if it was to keep pace with changing needs and technological and clinical developments. He observed with relish that he had an argument every single day as he put the case for reform.

What should future health secretaries do? The best pointer came from Hewitt. She stressed that the most important decision she made had nothing to do with NHS management – it was to push through the ban on smoking in public places. Within one year clinicians were seeing improved cardiac health from the reduction in passive smoking.

While demonstrable wins from management initiatives will always be elusive, robust action on public health is where health secretaries can make their mark on the sector’s history.