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After Lansley

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The reshuffling of Andrew Lansley is potentially the most significant sacking of a health secretary in living memory.

Within moments of his appointment as secretary of state for health Jeremy Hunt declared the new job a “huge task”. Despite the fact that the former culture secretary has been taking briefings on the health reforms since, at least, the start of the year, Mr Hunt knows he faces a brutal learning curve.

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Andrew Lansley held the Conservative health brief for nearly a decade – an almost unprecedented length of time. During that time he developed plans for the reform of the NHS which manifested itself in this year’s health act. Those plans were twisted by the coalition government’s negotiations and then revised endlessly during the passage of the act. However, the final product was recognisable as Mr Lansley’s vision.

That vision was a highly personal one. Few senior players in the Conservative party bothered to try and understand Mr Lansley’s plans and those that did make the effort become lost in the foot hills of the former health secretary’s immense knowledge.

Of course, as the reforms became reality senior figures in the health service had to get their head’s around the proposed changes. But, few if any, agreed with the totality of the health secretary’s ideas. The tattered narrative of the reforms was held together by one man.

And now he has gone and as a result those senior health service figures – led by Sir David Nicholson – will have their power and influence further increased.

There will be considerable protestations from Mr Hunt and all that having a new man at the top makes no difference to the direction of travel. That will not be true. We are not about to see any dramatic U-turns, but policies will begin to be retrospectively tweaked to fit a range of new agendas.

Mr Hunt’s focus will be on more effectively communicating change and getting negative NHS stories off the front pages. The implementation of the reforms – and crucially how that task is interpreted – will be largely left to civil and public servants.

Policy direction will be increasingly influenced by key advisors at Number 10 – just as it was during the Blair years. They will be focussed on making the electorate feel good about the NHS – and will care much less about the technocratic reforms so close to Mr Lansley’s heart. Choice and consistency of care will be the priorities, something that is likely to manifest itself in the first mandate to the NHS Commissioning Board due in October.  

But it would be disingenuous to suggest that Mr Hunt will simply be a PR man. Despite the analysis above, he faces a to do list that would daunt even the boldest of politicians.

His immediate check list includes, but is not limited to, deciding: if regional pay will work in the NHS; what he should do with South London Healthcare, the NHS’s first ‘bankrupt’ trust, and whether other struggling organisations should suffer the same fate; and if the Hinchingbrooke franchise model should be pursued at George Eliot or elsewhere.

Finally, of course, there is the publication of the Francis inquiry into care failings at Mid Staffordshire Foundation Trust which is likely to be published in November. As Sir David has acknowledged, the inquiry’s findings could clash with key elements of the reforms. Managing the consequences of that without a detailed knowledge of how the system hangs together will be fearsomely difficult.

In the longer term, of course, Mr Hunt has the challenge of being true to Mr Lansley’s word that the health secretary will remain above rows over hospital reconfigurations and the ‘rationing’ decisions of clinical commission groups. The health secretary’s job is very different to the one that Mr Lansley inherited. Will the new tenant of Richmond House be prepared to take the political risks that such a role carries?

Alastair McLellan, editor, Health Service Journal

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