On a bitterly chilly weekend in October 2015, the views of 20,000 junior docs, freezing in our scrubs as we marched on Downing Avenue, have been encapsulated in a single unforgettable placard. “I will not be a gynaecologist,” it learn, “however I do know a Hunt once I see one.”
No different well being secretary in NHS historical past has incensed the medical career fairly like its longest serving incumbent. Throughout his six-year tenure from 2012 to 2018, Jeremy Hunt presided over a catastrophic decline in NHS requirements, the ache of year-on-year austerity budgets, failed pledges to extend the scale of the NHS workforce (these 5,000 additional GPs he vowed to ship by 2020 shrivelled, in reality, into 1,425 fewer GPs) and, most infamously of all, a collection of unprecedented strikes by NHS junior docs.
As a placing junior physician myself, anti-Hunt sentiment in my family reached such a fever pitch that my then three-year-old daughter, on seeing a tall man strolling into the hospital the place I labored, as soon as shrieked: “Mummy! Jeremy Hunt is strolling into your hospital.” “Oh expensive,” I mentioned. “What do you assume I ought to do?” “Go in after him and chop off his head.” These have been supercharged, horrible occasions.
Even at this time, six years after the dispute limped to an ignominious finish (Hunt duly imposed his despised new contract), my informal point out within the docs’ mess that he has written a guide about, of all issues, affected person security triggered a volley of anatomically strong invective. Zero, the brand new guide in query, is subtitled Eliminating Preventable Hurt and Tragedy within the NHS. Its ambition can't be faulted: “Zero is a guide about how the NHS can scale back the variety of avoidable deaths to zero and within the course of lower your expenses, scale back backlogs and enhance working circumstances,” Hunt writes. “Delivering the most secure, highest high quality care within the NHS post-pandemic may very well be our very personal 1948 second.”
If I learn this accurately, Hunt is suggesting that his blueprint for the well being service is so radical it might rework the supply of healthcare for the British public as dramatically because the inception of the NHS three-quarters of a century in the past. Which raises a quite apparent query. Provided that he was the longest serving well being secretary in NHS historical past, why didn’t he impose his imaginative and prescient whereas in workplace, quite than ready for the tumbleweed of the backbenches to put in writing about it?
Hunt would argue he tried to do exactly that. Affected person security has been his mantra for years. Particularly, he writes, he needs to get rid of the 150 avoidable deaths that happen within the NHS each week. Not like demise from ailments reminiscent of most cancers or coronary heart illness, these come up from primary medical error. Repair the errors and “each single one among them is instantly preventable. We aren't ready for a miracle treatment. They may very well be stopped proper now if finest apply have been adopted.”
Framed like that, it’s an arresting argument. Hunt elaborates. Traditionally, he explains, NHS tradition has been opaque and evasive. When whistleblowers attempt to increase affected person security considerations, as a substitute of listening to them, NHS trusts destroy them. Within the worst circumstances – and Hunt describes quite a few examples of neonatal deaths and failures of care in painstaking, heartrending element – bereaved family members could be left combating for years as NHS establishments shut ranks, protecting up their wrongdoing. What's desperately required in healthcare, then, is a root-and-branch cultural overhaul. Above all, Hunt argues, we want candour, a no-blame tradition and a honest willpower to deal with each mistake as a chance to learn to do higher subsequent time.
Disconcertingly, I totally agree. Extra disconcertingly nonetheless, whereas researching this guide, Hunt contacted me to ask if he may talk about the place he’d gone unsuitable within the junior physician dispute. To my shock, he sat and really listened, even once I instructed him that pretending to the general public he may construct a safer “seven-day NHS” with out growing physician numbers was not solely dishonest however “fully moronic”. Zero, it seems, is a considerate, severe and well-written guide that tackles an immensely vital topic. On one stage, Hunt is clearly moved by poor affected person care. He describes repeatedly sitting with members of the general public who share tales so grim they scale back him to tears. It's arduous to think about his successor, and notorious lockdown rule-breaker, Matt Hancock doing that.
However that is additionally the work of a consummate politician. The prose, in a phrase, is emollient. Hunt glides seductively over his observe report in well being, utilizing omission and elision to rewrite historical past. He insists, for instance, that simply earlier than leaving his submit he efficiently negotiated “the biggest single [funding] improve in NHS historical past”. Though technically true (inflation alone means the scale of the NHS funds rises yearly), the five-year settlement for 3.4% annual funding will increase failed to deal with the crippling affect of austerity budgets, didn’t even match the typical, long-term NHS funding improve of three.7% since 1948 and was criticised by the Nationwide Audit Workplace as being insufficient and unsustainable. Whereas in workplace, Hunt oversaw the slowest interval of funding within the NHS since its basis, a reality he pointedly ignores.
What's most disappointing from a frontline perspective is Hunt’s failure to match his tremendous phrases on candour with motion. I write as somebody who this 12 months has seen too many sufferers dying in distress to depend. They’ve died on trolleys within the corridors of overwhelmed hospitals. Of cancers that ought to have been identified months in the past. In their very own blood or excrement as a result of the nurses are run ragged. In ambulances trapped exterior jam-packed A&Es. The record goes on and on. Avoidable, ghastly, inexcusable deaths, the outcome not of medical error, however of a system so defunded and understaffed by the federal government that it's doomed to fall wanting what sufferers deserve.
Political decisions, in brief, are inflicting avoidable deaths right here, now, in each NHS hospital within the nation. Hunt is aware of this but chooses to not voice it. Presumably he nonetheless has one eye on Downing Avenue. And that’s the factor about candour. You'll be able to’t credibly advocate whole transparency whereas dipping out and in of being candid when it fits you. A real affected person security champion would lead by instance, talking out about all sorts of affected person hurt, together with these inflicted by their social gathering in authorities.
Rachel Clarke is a palliative care physician whose most up-to-date guide is Breathtaking: The UK’s Human Story of Covid (Little, Brown).
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