Goodbye Hunt, Hello Hancock

Ultimately, a health secretary can only be judged by whether the health service and health of the nation was better on leaving office than entering it. On both these counts Jeremy Hunt – in post for nearly six years – does not fare well. Getting access to the NHS, and the times spent waiting for treatment,  deteriorated across the board from emergency departments to cancer care, with over 4 million on a waiting list. The gap in life expectancy, and years lived in good health, between rich and poor is as large as ever, and steady improvements in life expectancy flatlined between 2015-2017, and remain lower than in many other comparable countries.  Most alarming,  the number of babies dying within a year of being born is on the rise, from 2.6 neonatal deaths per 1,000 births in 2015 to 2.7 for every 1,000 births in 2016. The likely causes are smoking among mothers, maternal obesity, poverty, cuts to public health programs and the England-wide shortage of midwives.

Clearly not all of this was Hunt’s fault, but it seems odd such widespread failure was deemed worthy of promotion to foreign secretary. Hunt’s tenure was blighted by his predecessor’s reforms and Tory austerity that reduced the average funding increase of the NHS from 4% to 1%, crippled social care and cut benefits. If government policies were ranked according to how many people they killed, this would surely come top. The Conservatives in 2015 then made manifesto promises to match the daftest Brexit fantasies; ‘To introduce a truly 7 day NHS than would be the safest and most compassionate health service in the world’ without the funding or staffing to do it. The queues around the block in many emergency departments sparked accusations from the Red Cross of a humanitarian crisis and showed the absurdity of the lies. And a battle with junior doctors and the BMA born out of anger and frustration cemented his dire legacy. Hunt took a keen interest in some aspects of patient safety but ignored what the NHS really needs to be safe and compassionate – legally mandated safe staffing levels.

Hunt could have just handed over all responsibility for running the NHS in England to NHS England, and kept his head down. However, he was always ambitious and keen to be in control, ordering trust bosses to report to him directly every Monday morning. This allowed NHS England CEO Simon Stevens to play him, ensuring Hunt took  the flack for failures in the NHS whilst painting himself as the brave administrator demanding more funding. A pincer movement from Hunt and Stevens probably helped secure the 3% rise in NHS funding from next year to 2023. But nothing can stop another meltdown in NHS services this winter, which now falls in the lap of young Matthew Hancock.

Hancock has much in common with Hunt, ambitious and overly optimistic that technology can save the NHS. It could certainly help. The NHS currently operates on the CATNAP principle (Cheapest Available Technology Narrowly Avoiding Prosecution) and there would probably be significant gains for staff and patients if vital information moved swiftly around the service from homes to high dependency units. Alas, all previous attempts have not managed to join up the myriad different IT systems. Hancock knows he only has a few weeks before winter kicks in and so has been going for quick wins. Within days of taking office, he declared his love for and undying belief in the NHS. He then pledged to “defend and champion undervalued NHS staff.” Legally mandated safe staffing levels would be a good start, but unlikely in a service with 100,000 vacancies, and made worse by Brexit.

Instead, Hancock has specifically endorsed GP at Hand, the Babylon-powered digital GP practice, declaring it to be his GP, and wanting it available to all. MD has nothing against online consultations (we use Skype very successfully for patients with severe fatigue for whom travel is exhausting), but generally those who sign up to GP at Hand, which diverts funding away from their regular GP to the company, are relatively young and fit. So GPs are left with less money to deal with older, frailer patients with multiple diseases who take up the bulk of NHS funding and time, and who are most likely to be failed and harmed by lack of services, and end up in a queue in hospital this winter.

All new services need to be properly evaluated, particularly if they use AI symptom sorters too (Eye Oct 2017), but Hancock knows that this takes time which he doesn’t have. So he’s rolling the dice on ‘disruptive innovation’ knowing that if problems arise, Babylon may fiercely defend their reputation with legal threats, as it has done in the past. It even took the Care Quality Commission to court in 2017, but failed to stop the publication of a report that stated it was not providing a safe service in some areas. If staff, users and regulators aren’t free to voice honest concerns, Hancock and Babylon will fail.