Is Jeremy Hunt's vision for the NHS already mired in difficulty?

http://www.theguardian.com/healthcare-network/2015/jul/17/jeremy-hunt-vision-nhs

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Jeremy Hunt’s “25-year vision” for the NHS, unveiled this week, is an amalgam of rapid change, inspiring transatlantic collaboration, another round of institutional demolition, a gimmick and a plan for the release of dodgy patient safety data.

The ultimatum to the BMA over seven-day working – forcing through new seven-day contracts – reflects frustration at the excruciatingly slow progress towards achieving this key patient safety goal. Getting it in place has been dogged by questioning of the mortality data, demands for more money and arguments over the out of hours availability of support services. While all these have their merits, they do not amount to a justification for endless prevarication. It is a tough deal for doctors, but it will drive through a crucial and long overdue cultural change.

Related: Jeremy Hunt's divisive approach to seven-day NHS services benefits no one

But forcing through the gradual adoption of new contracts does not mean it can be done for free. The contracts will not be enough to deliver the change in hospitals sliding into deficit. It is possible that some trusts will find efficiencies from seven-day working but most will need sizeable up-front investment.

In another move to accelerate change, Hunt unveiled a collaboration with the Virginia Mason Medical Center in Seattle, internationally renowned for adapting the Toyota lean production system to patient care. Five trusts are to benefit from a £12.5m, five-year partnership aimed at importing its transformative ideas.

Virginia Mason has a relentless focus on quality and safety, highly effective use of technology and strikingly motivated staff. It achieved this through a sophisticated reform drive which changed the relationship between the organisation and its doctors, establishing the highest standards of professional conduct with staff support. It is an outstanding role model for the NHS in what it achieves and how it got there.

The long-trailed merger of the NHS Trust Development Authority and Monitor is an obvious step, but it symbolises the diminution of the foundation trust model as increasing numbers of them slip into financial difficulty. The decision to call the new organisation NHS Improvement has rightly been met with groans. No amount of fluffy language can hide the fact that the regulator will be trying to hold together a financial system which could run to a deficit of £2bn this year.

But it will have clinical teeth, hosting a new Independent Patient Safety Investigation Service – modelled on the Air Accidents Investigation Branch – to reveal the underlying reasons behind major patient safety failures. This should go some way to improving the NHS’s poor record of understanding and learning from major incidents such as Morecambe Bay.

Less convincing is Hunt’s decision to publish avoidable deaths for every trust. There may be a good reason why it would be a world first; it is highly questionable whether such a figure can be calculated reliably. The consequences could be profound – scaring patients and undermining staff morale with a meaningless number. That is a perversion of the notion of “transparency”.

Related: Seven-day NHS: five questions that need to be answered

He is on firmer ground with the plan for the King’s Fund to rate the care for different patient groups by health economy. Looking at how patients are served by the system rather than by individual institutions will encourage a focus on the whole patient pathway.

Elsewhere in the improvement jungle, the NHS Leadership Academy has been folded in to Health Education England. While that makes sense, the repeated ripping up of health service improvement bodies – which has been going on for decades – undermines effectiveness and credibility.

Elsewhere in his vision, Hunt couldn’t resist the gimmick of appointing technology guru Baroness Martha Lane-Fox to explore “digital innovations” for the NHS – as if there hadn’t been enough reports on the potential of technology to transform healthcare.

Hunt has now made his mark. He is beginning to deliver seven-day working, he is pushing the system hard to improve patient safety and there is encouragement to learn from the world’s best. But the spectre of the NHS deficit still haunts his reform plans.

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