A member of Boris Johnson’s team asked me, when Jeremy Hunt was elected Chair of the Health Select Committee, whether the former Health Secretary should properly hold the post.
He meant that Hunt was in the problematic position of marking his own homework, since some of the problems his committee were examining date back to his own period in office (if not earlier).
Or as a tweet once put it: “Hunt currently on Channel 4 News bemoaning the NHS staffing crisis. He’s going to be furious when he finds out who did sod-all about this between 2012 and 2018.”
The reason I know about this take on Twitter is that the former Health Secretary has put it in his new book, Zero, which ConservativeHome will review in due course.
But it’s worth anticipating whatever we write by reflecting briefly on what the book has to say about the NHS and what it tells us about Hunt.
The arrresting Zero of the title is the number of unnecessary deaths that he believes the NHS should be aiming to achieve.
Both the Stafford Hospital scandal and the Furness Hospital one took place before Hunt’s appointment as Health Secretary under the Coalition.
But babies’ deaths at Furness, which some staff attempted to cover-up, and adults at Stafford, where some patients were left in their own urine, clearly shocked him when the inquiries came.
There are some harrowing stories in the book about avoidable deaths in both places and elsewhere within the NHS. Rather than quote some I will, for the sake of economy, cite another figure.
Hunt says that there are 150 unnecessary deaths a day, the number he wants to reduce to the lowest possible. You may say that patient deaths is a partial and thus a flawed prism through which to view the whole system.
Hunt concedes yhat it doesn’t offer a synoptic view, but this doesn’t detract from the energy, intelligence, self-criticism and, to deploy a perhaps over-used word, compassion that he brings to the subject.
Furthermore, the drivers of avoidable deaths – a blame culture, targets (if misused), hierarchies, short-staffing, defensiveness and litigation are also the drivers of wider problems within the system.
You must read the book yourself to get the sweep of the changes that he believes are necessary, and I will pause over only one which he says he dismissed when Secretary of State as too cloudy to prioritise.
Namely, a change in the culture of the NHS itself, and some critics of the service on the right would add that problems with its culture are driven by its nature, which is why it should be replaced by an insurance system of some kind.
You hear a lot from some about the relatively poor quality of NHS outcomes, and Hunt quotes a Commonwealth Fund analysis which puts it ninth out of eleven broadly comparable countries.
You will hear less from the same quarters about other measures, which ensure that the health services comes in fourth overall.
“The NHS scores especially well for the equity of its system, its low administration costs and the speed and safety of care,” he writes.
Lord Ashcroft concluded in his own recent book on the system that it would be impracticable as well as unwise for the Conservatives to seek the tear the health service up and start all over again.
That seems to me to be a statement of the politically obvious, but the research that Hunt quotes is a reminder that health policy, like so much else, requires trade-offs.
Aneurin Bevan traded off worse outcomes than we might otherwise get for more equal access – and other reforming health secretaries, such as Ken Clarke, Alan Milburn and Andrew Lansley have not shifted this elemental dial.
Hunt was not a reformer in the sense of, as David Nicholson said of the Lansley programme, making changes so big “that you could probably see [them] from space”.
He sought to calm the waters that his predecessor had troubled, as is sometimes the case at health and elsewhere, stressing inspection and data, and thus improvement and savings.
The other side of criticism to his chairing the Health Select Committee should be praise for him wanting to do so at all – especially given the context.
Politicians who have served at the top are sticking for less long than they did, and Hunt could quite easily have pushed off at the last election, having failed to win the Tory leadership, and gone to make money elsewhere.
And former Secretaries of State don’t always develop a passion for their subject, though Lansley and Stephen Dorrell, another of Hunt’s predecessors, are among the exceptions to the rule.
He has to be given credit not for concluding that he’d had enough, and would concentrate on other matters if he stayed in the Commons, but instead for rolling his sleeves up and mucking back in.
There is rather a lot of reporting at the moment about the bad character of some MPs, and Hunt is a reminder that this isn’t so in all cases, to put it mildly. There is a touch of the Head Boy about him (unsurprisingly, he was one).
It will be claimed that his book is an attempt to keep his name in lights as he continues to pursue the Conservative leadership.
By his own admission the latter is more or less the case, but the history of the book casts doubt on the former. He says that he planned to published earlier, but was held up by one thing or another (such as being Foreign Secretary).
He will know that the odds of Boris Johnson being tipped out have lengthened recently, though there will never be a shortage of action at the bookmakers.
Could he be Tory leader and Prime Minister if Johnson fell? When they fought it out in 2019, I supported Johnson and our proprietor Hunt.
I believed that the former was more likely to win a general election conclusively. Lord Ashcroft believed that Hunt was more likely to govern well. There is no proof of the latter, but I suspect we were both right.
At any rate, Hunt is the best-known and best qualified of the potential successors, in the sense that he’s been around at a senior level for longer.
He’s made mistakes, I hear you say. And he says so himself in this book. So much the better: any politician with his experience will have done so, and have the chance to learn from them.
What you see is what you would get: decent, sensible, moderate government, though there a questionmark about strategic intent.
Brexit shouldn’t be the be all and end all of judgement, but I found his shifts from Remain to a Norway-ish position to a harder one hard to compass, though in fairness he’s scarcely the only politician to have shifted view.
He plainly has little time for the Prime Minister, whose qualities he recently failed to praise, and any prospect of his future return to office is linked to Johnson leaving it.
Only one former Tory leadership candidate, Michael Howard, has made it second time round (if you discount Johnson’s own spectacular withdrawal in 2016) – and that was under circumstances unlikely to apply soon.
Hunt would be more likely in my view to be restored to office by someone else, perhaps to his last job as Foreign Secretary…or as Chancellor.
Footnote: during the last leadership campaign, he wanted “to cut corporation tax to Irish levels, 12.5 per cent, which is one of the very lowest in Europe and even in the world”.