Former health and social care secretary Jeremy Hunt was in the virtual hot-seat for the latest HealthChat with veteran NHS commentator Roy Lilley. Lyn Whitfield listened in.
As Roy Lilley’s latest HealthChat got underway, its guest was missing. Former health and social care secretary Jeremy Hunt was still in the queue to vote on the government’s Covert Human Intelligence Sources (Criminal Conduct) Bill.
Or, as he put it, when he arrived on the Zoom call: “I have just been voting to give our spies more power.” Once the discussion started, though, there was only one topic of conversation: the novel coronavirus pandemic, and the government’s response to it.
Shooting for the moon
Lilley, a veteran commentator on the NHS who leads the Institute of Healthcare Management and the Academy of Fab Change, which hosts the HealthChats, has made no bones about condemning that response in his almost daily newsletters.
So he started by asking Hunt why, when he wasn’t voting on spy bills in Parliament, he was grilling his successor, Matt Hancock, on when England would hit its “moonshot” target of testing everybody in the country once a week.
“[It’s because] I think the uncertainty is killing us,” Hunt replied. “Everybody wants to know if this is still a danger, if they can get it, whether they are ok to go to work, or they are going to pass it on to their family. If we can pick up the asymptomatic carriers, then we can answer some of those questions.
“My argument is that we are on to be testing 1 million people per day by Christmas, so let’s have a date for getting to 10 million a day, whether that is 1 April or 1 May or whenever. Then we can get back to some kind of normality.”
Just what has gone wrong with TAT?
Naturally, Hancock had declined to give a date when asked for one in the House. He is hardly going to put up another hostage to fortune when his department has missed so many Covid-related target dates.
Particularly when there is so much scepticism in press, medical and council circles about whether NHS Test and Trace is up to the job. “What,” Lilley asked, “has gone wrong with test and trace? Dido [Harding, the Conservative peer who heads NHS Test and Trace] is busting a gut and it is just not happening.”
On the contrary, on the day of the HealthChat, the organisation had hit a new low on the trace part of its job; with figures showing that it is now reaching just 60% of the contacts of people who have tested positive so it can ask them to self-isolate.
Hunt said several things had gone wrong. First, the big pandemic planning exercise that he had been responsible for in 2013 had overlooked testing. “We had a blind spot.” That meant that when the novel coronavirus arrived, public health services weren’t ready.
Then, the government “made a mistake” by stopping testing. So, by the time they decided to get it going again at scale, the only option was a highly centralised system. When: “As Germany has shown, the only model that works is the local model.”
With a local model, Hunt argued: “You can get a competition going between localities to see whose hospitals and labs can do it best” and you can improve compliance. “People are much more likely to comply if it is somebody from the local council that calls up, who might actually be able to come around and check, than if it is somebody in a call centre hundreds of miles away.”
Why has it been so hard to develop an app?
At the same time, Hunt added, England does need an effective app; and one that will work with mass testing to allow people to prove their Covid-status when they need to.
Naturally, this prompted Lilley to ask about what he called the “shambles” of the NHS Covid-19 app; which NHSX first tried to build itself, and then had to abandon in favour a ‘decentralised’ model of alerting, based on a model developed by Apple and Google.
“Why did we try and build something when we could have gone to China or anywhere and just bought something that worked?” he asked. Again, Hunt suggested it was not that simple.
Other countries, such as Singapore and Germany had tried to build their own apps only to move on, not least because Apple had refused to play ball with them. So: “I don’t blame the government, because the app would have been great if it had worked,” he said.
Even so, Lilley pointed out that apparent failures like NHS Test and Trace, and the App, and now local lockdowns had bred disillusion and even anger; which was now manifesting itself in the refusal of some big city mayors in the north of England to refuse to accept ‘tier three’ restrictions because of their impact on livelihoods.
Surely, he suggested, the government would have to respond at some point by improving its compensation offer. “The thing is the money,” he said. “If [people working for businesses that have to close because of the new restrictions] get two thirds of their pay, they can’t just pay two thirds of their bills.
“And there are people who are going onto benefits and have never claimed in their lives and just don’t know how to make sense of the system. Surely, it would be easier to scrap all of its and say ‘we will pay something like 90% of your wage as a Covid-wage?’”
Looking beyond the pandemic
Hunt is far too experienced a politician to be pushed into making those kinds of calls on the Treasury, which must also be terrified of introducing a national, universal basic income by default. However, he argued that as the country finally emerges from the pandemic, there will need to be a new settlement for the NHS and for social care.
“When I was health and social care secretary, I wanted a ten-year plan and ten-year funding for social care,” he said. “I got a ten-year plan and five-year funding for the NHS, but I didn’t get that. I hope that after this year, after Covid, we will be able to fix that system.
“Everybody has been able to see how brilliant it has been, and it would be a waste not to do it.” Hunt acknowledged that fixing social care would mean putting more money into the system and that this would mean tax rises.
He argued that it should be possible to build the social consensus for this; but “it is now or never.” In response to a question from the HealthChat’s large online audience, he also argued that there is a need for more integrated health and social care, even if this means dismantling much of the NHS structure that he inherited from Andrew Lansley.
Lansley’s 2012 reforms, he told Lilley, were fine for encouraging competition between providers for elective care; but “elderly care, looking after people with multiple chronic conditions, requires a different model.” Lilley agreed with this wholeheartedly.
In his newsletters, he often argues for an integrated model, and the reintroduction of something like the health authority he used to run. “I agree with Roy!” Hunt joked. “It’s the end of your career,” Lilley responded.
Looking forward to being PM?
Hunt is far from done with healthcare, however. He chairs the Commons health and social care committee and is doing interesting things with the role.
Earlier this year, it proposed awarding CQC-style ‘star ratings’ to government progress on its stated policies. It has just announced a joint investigation, with the science committee led by another Conservative former minister, Greg Clark, into the government’s Covid-19 response.
In making the announcement, the two committees said they wanted to question key figures and then issue interim recommendations that would be more helpful in guiding its next steps than the eventual public inquiry will be. How helpful prime minister Boris Johnson and his cabinet will find this is an interesting question.
Lilley has absolutely no time for Johnson, who he described to Hunt as a “dishevelled mess” who is incapable of putting together “any kind of plan” for navigating the covid-crisis. But Hunt argued the government has had some successes, such as confining the second wave to large cities.
He also laughed when a member of the online audience asked if he was “looking forward to being prime minister.” Hunt ran for the job against Johnson and has been tipped as a possible successor if Covid and Brexit bring him down.
But he insisted that “I am enjoying stepping back from government to care for my three young children” and while “I get” what Lilley and others think about Johnson, he is not looking for his job.