Jeremy Hunt was the SoS for Health for the longest period since the war. In these eLetters, I called him The Tinkerman…
… because all he could do was ‘tinker’ with the NHS.
He was the boss during a ten year period of austerity, which meant flat-line funding. He had no money to do, change or improve very much.
It was a period of political turmoil. He had almost no parliamentary time to legislate, to change very much.
That’s the context, backdrop to his book, Zero.
He was bossman during a very dry patch. If the NHS was an allotment, the beans wouldn’t have climbed very far and the onions would have been pretty small.
It’s no good criticising Hunt, for ‘not doing anything while he was in power’. He had precious little wriggle room.
To escape the constraints of the Treasury would have required the talents of Houdini.
At the end, with the help, of the then NHS chief executive, Simon (now Lord) Stevens, they did manage a bit of Tommy Cooper…
… Hunt claims, ‘the largest single £increase in NHS history’…
… just like that…
… actually, the five-year agreement for 3.4% annual uplift, didn’t match the long-term average for NHS funding increases… 3.7%, since, 1948…
… now you see it, now you don’t.
But, it provided certainty. Almost as important as money.
The book’s central theme… finding a way to end patient harm.
Hunt is frank; the extent of errors and harm shocked him. No one can speak with the relative of a patient who has come to a bad-end, in the hands of the NHS, without being moved, angry, dismayed, and puzzled in equal measure.
There are 150 avoidable deaths every… no, not a year. Not a month… but every week. There’ll be twenty, today.
Zero, is the quest for zero defects… technically possible but…
… in realty;
- The Six Sigma standard defines zero-defects as 3.4 defects per million opportunities.
- The NHS sees a million people a day.
- If there are just 20 procedural interfaces, for each one, that could fail, (in reality, for some there’ll be many more)…
- that’s 20 times a million, twenty times, for a defect opportunity.
An infinite possibility.
The big shift, Hunt never attempted, was to end the reliance on the work of CQC inspection, to improve quality.
There’s no evidence inspection improves anything. Shifting to data-analysis, as the foundation for forecasting errors, was within his grasp but beyond legislative will.
End the blame culture?
Regulated professions run for cover when there’s a problem. Reputations, careers, incomes and self-worth can all disappear in a moment of hesitation, misunderstanding or error.
The NHS will not be safe all the while it is not safe to say;
‘I made a mistake.’
Neither will it be safe until it’s safe for someone to say;
‘I know who made a mistake.’
Hunt knows that but moving to a no-blame-culture means changing;
- medical training,
- the courts,
- indemnity,
- the press
- attitudes…
… and a DH and NHSE who only have the levers of bungs and beatings to impose their will.
Change will take intention, intellect, courage and subtlety.
Hunt’ll be, mostly, remembered for a head-on collision with the Junior Doctors.
He had no chance. The Docs had the public on their side. Hunt had neither the Treasury, nor the Cabinet on his.
I know, from personal involvement; the Junior Docs were badly lead and mislead, by people who intended to spin the dispute out, into the winter and across Xmas.
Hunt brought in a white-knight, Sir David Dalton, a wise and safe pair of hands, to look for an end. He gave up; ‘… the Doc’s don’t want to settle.’
Finally, Hunt imposed a settlement.
Learning? Industrial disputes are a failure for everyone.
He promised to increase the workforce and didn’t. He admits that. He created more university place to train the next generation and has since, tried to place a statutory obligation on HMG, to plan a workforce. They’re having none of it.
What of this book? It’s well written, readable, frank.
Learning? Not that Hunt failed, nor the NHS fails…
The real learning; the damage HMG’s austerity policies did and the failure to find the courage to do what could have been done, with no money.
And, the unspoken question is; has Hunt learned enough to be the next PM?
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
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