THE BLOG

Jeremy Hunt Is Playing a Dangerous Game

25/05/2013 15:19 | Updated 25 July 2013

For some time now, Labour has been warning him about building pressure in A&E. For 33 of the 36 weeks he has been Health Secretary, major A&Es have missed his government's target.

He began by simply ignoring us. But then, about a month ago, a new spin operation began: the 'root cause' of today's problems in A&E, he declared, is the 2004 GP contract.

When Jeremy Hunt was appointed, improving PR was the first line on the orders given to him by David Cameron. His main job was to repair the damage done by the communications omnishambles also known as Andrew Lansley.

So perhaps it is no surprise that, seeing the developing A&E chaos, the health secretary and his advisers trained their sights on the GP Contract. After all, it followed the classic government script: 'blame the profession, the previous government and claim it's nothing to do with us'. The GP Contract fitted that bill well. it was a convenient target - the perfect political smokescreen.

In other policy areas, it might be possible to get away with such simplistic spin. But, as Jeremy Hunt is learning to his cost, it just won't hold in the complex world of modern healthcare.

Labour began by pointing out that his explanation did not sit well with the facts. Yes, in places, there have been problems with GP Out Of Hours services. But, in 2009, five years after the introduction of the GP contract, 98% of patients were seen within four hours in A&E. It is in the last two years that standards have dipped - under the government's watch - and in the last year that there been a sharp deterioration. If today's problems are all down to a contract signed nine years ago, why have they only surfaced now?

A&E has gone downhill since the NHS was plunged into the chaos of top-down re-organisation, with eyes distracted by back-office changes and taken off front-line patient care.

Things took a more serious turn for the health secretary when it emerged that an NHS England board paper on pressure in A&E identified a range of complex causes for the pressure, including staff shortages and over-stretched social care. This opened up a clear gap between the Secretary of State's public statements and the official advice from his experts.

By the time the Health Select Committee had concluded its deliberations on Tuesday, Hunt's humiliation was complete. Mike Farrar, Chief Executive of the normally reserved NHS Confederation, told the Committee he saw "no correlation" between A&E four-hour performance and the 2004 GP Contract.

Now you might ask: why does all this matter in the real world? Isn't it just typical Westminster point-scoring?

The answer is it matters hugely; the more he sticks to his spin, the longer he will be diverting attention from the real causes. And the longer he neglects the real causes, the more dangerous the situation will become.

His response to the pressure he has been under has been to intensify his attacks on GPs and the contract. He has gone so far as to promise yet another re-organisation - this time of primary care. GPs responsibilities will be increased and a new Chief Inspector of General Practice will be appointed.

For political reasons, Jeremy Hunt has turned this whole issue into a crisis of primary care. The trouble is he has a real crisis in A&E that isn't going away - and the measures he is proposing won't solve it, as the advice from NHS England makes clear. In fact, by focusing his department's attention on the wrong target, he could make matters even worse. That's why this situation is becoming dangerous.

So what are the issues that the Health Secretary should be focusing on instead?

As politically difficult it might be for a government that likes to blame others, it needs to start reversing some of its own policies that have added to the problems.

For a start, he must step in to sort out the problems with the botched introduction of the 111 service. There are continued reports of huge numbers of calls abandoned and inexperienced call handlers wrongly advising people to attend A&E.

Next, a halt should be called to any further closures of NHS Walk-In Centres. In addition, Jeremy Hunt should personally review all the A&E closures that are proceeding apace under his government.

His next priority should be to stop further front-line job losses and ensure all hospitals have safe staffing levels. The CQC's finding that one in 10 hospitals do not have adequate staffing must be addressed.

However, this brings out a dilemma for Jeremy Hunt. He has realised to his cost that David Cameron's much-maligned re-organisation has removed his powers to intervene. Embarrassingly, It was reported two weeks ago that, when the Secretary of State tried to cobble together a package to relieve the pressure, officials spent all day trying to "hold him off". He was left looking weak and ineffective.

This is worrying as extra funding is urgently needed to shore up collapsing social care services - in my view the primary driver of the A&E problem.

The consequences of the government's decision to cut councils to the bone is now being felt.

Councils of all political colours are having their budgets slashed and are not able to provide the necessary care and support, particularly to help older people stay at home. As a result, people are failing to cope and presenting at A&E as emergency admissions.

The problem is compounded at the other end of the process. Even when people are ready to return home, they are often delayed as home-care can't be arranged. So beds remain full. This increases pressure on A&E as it can't admit people to the wards. And, in turn, A&E becomes full and ambulances have to queue outside.

This is why A&E is the barometer of the whole health and care system. Whenever and wherever there is a blockage, the pressure backs up through A&E. And this explains why the challenges facing Jeremy Hunt go way beyond GP Out Of Hours services.

It also explains why Labour is now seen to be leading the health and care debate - and the government forced to follow - with our radical plans fully to integrate health and social care.

The simple truth is that the Secretary of State will never be able to spin his way out of this situation. The longer that he tries to do so, the more he will neglect the real causes of the problem.

As Jeremy Hunt is discovering, playing politics with A&E is a dangerous game. He has dug himself into a hole and, for all our sakes, he needs to get himself out - fast.

Jeremy, it's time to cut the spin and get a grip.