Andrew Lansley was not a popular health secretary.
When David Cameron ousted him from the position, responses ranged from branding him the man who ‘pushed the NHS to brink of destruction’ to ‘one of the worst health secretaries since the NHS was formed’.
After two years dogged by controversy – most notably for his plans for a complete NHS overhaul – the move to replace him was welcomed by many.
While it wasn’t unanimous and the 55-year-old did receive praise – mostly from Conservative colleagues – their voices were drowned out under waves of criticism.
Mr Lansley became best known as ‘the architect of the reforms’. Under his guidance, proposals were pushed through parliament for ‘fundamental changes’ to the NHS and there was vehement criticism that plans were being rushed through and put cost before quality.
Most controversial was – and still is – the move towards ‘privatisation’ of the NHS and welcoming competition from the private sector.
But now the ‘architect’ has been removed from post and former culture secretary, Jeremy Hunt, has been drafted into the position.
What does this mean for the reforms? Are we expecting a coalition U-turn?
In short, no. The reforms have already gone through parliament and are well on their way to being implemented.
And in his speech at the Tory conference in October, Mr Hunt even went so far as to call Mr Lansley ‘brave’ for ploughing ahead with them.
Shadow health secretary Andy Burnham tells Midwives that he believes Mr Hunt has just been brought in to rebrand the reforms.
‘It is a strange situation,’ he says. ‘I thought Jeremy Hunt would have used the opportunity to make a break with what’s happened, but clearly he has not and I actually think he’s got a more pro-market agenda than Lansley.
‘He’s been brought in because he has a better bedside manner than Lansley.
‘The planning is clear – it’s about the presentation, it’s not about changing the decision, but putting a better face on this and trying to manage the PR of the reforms.
‘I don’t believe that he is a supporter of what the NHS stands for. I think it’s inevitable that we are going to go further towards privatisation – he’s very much a marketer.’
When Midwives requested an interview with Mr Hunt, he was not available for comment.
But health minister Dr Dan Poulter says that the government will push hard to follow through with Lansley’s reforms.
‘These reforms will make the NHS more efficient and better for patients,’ he says, ‘not least because they will dramatically reduce bureaucracy and waste – saving £5.5bn before 2015 and saving £1.5bn every year after that. This means more money reinvested into what matters – looking after patients.
‘One of the other crucial things they do is put clinical staff in charge. They open up new leadership opportunities for midwives.
‘I know from my own experience working in maternity that the more midwives are involved, the greater choice we can offer women and the more personalised the care.’
While Dr Poulter may have NHS experience, one of the main concerns voiced about Mr Hunt as health secretary is that he doesn’t have the health background Mr Lansley had.
‘On a personal level, I’ve always got on well with him,’ says Mr Burnham. ‘But I think the NHS is something that you’ve got to have an instinctive feel for and I think his lack of track record in health is a problem, given that he’s come in to one of the most dangerous situations that the NHS has ever faced.’
But, while he doesn’t have a healthcare background, Mr Hunt does have a reputation of delivering. In his last position he was responsible for the Olympics and oversaw the smooth running of the event this summer.
There were problems – mainly security firm G4S not having enough staff and the armed forces being drafted in at the last minute.
But praise after the event was almost universal, with International Olympic Committee boss Jacques Rogge even calling it ‘the most extraordinary event in our lifetimes’.
After the success of the Games, Mr Hunt hasn’t had the smoothest start in his new post.
He has already come under fire following claims that he previously ‘called for the NHS to be dismantled’.
The latter statement follows a book he co-authored in 2005, called Direct democracy: an agenda for a new model party. It says: ‘Instead of tinkering with a fundamentally broken machine, it [the Conservative Party] should offer to update the model.’
But a DH spokesperson sweeps aside these claims and calls them ‘nonsense’.
‘In fact, the book in question says that “we can hold to the ideals of the NHS, guaranteeing care for all, irrespective of their ability to pay”,’ the spokesperson says. ‘That is a view widely accepted across the political spectrum.’
Mr Hunt has also come under fire over the last couple of months over his views on abortion and homeopathy.
Mr Burnham says the fact that Mr Hunt has spoken out in favour of homeopathy ‘will raise a few eyebrows’ and that there are better areas for resources to be channelled into.
Mr Hunt’s views on abortion have also caused controversy after he backed reducing the limit to 12 weeks in a ‘free vote’ on abortion.
In free votes, usually granted on issues of conscience, such as capital punishment and Sunday trading, MPs can vote as they wish and are not under instruction from their party.
‘When this came to light, Hunt said that he was guided by evidence,’ says Mr Burnham. ‘I don’t believe that such evidence exists. I found that statement troubling, as the evidence would point you in the opposite direction.
‘You’d like a health secretary to be evidence based in approach and I’d question whether he is driven by the evidence or the ideology.’
But David Cameron backed his new head of health and said: ‘He is absolutely entitled to hold an individual view, a view of conscience.’
But there was good news in October, with the prime minister and Jeremy Hunt pledging £140m for midwives and nurses to ‘improve care and beat bureaucracy’.
The money will be invested in technology and leadership and Mr Hunt says ‘the government’s role is to listen to the NHS and support these leaders and that’s what we’re doing’.
The notion that the government will ‘listen to the NHS’ has left Mr Hunt’s lips more than once over recent months. It comes after one of the main criticisms levelled at Mr Lansley was that he didn’t listen.
As soon as Mr Hunt was in post, Unison said ‘Jeremy Hunt has an opportunity to listen to patients’, while Unite blasted Lansley’s ‘unlistening and steamroller mindset’.
‘One of the things I’ve heard a lot is Lansley would not listen to people and that’s not a good trait to have in the NHS,’ Mr Burnham says.
But, with Mr Hunt emphasising his willingness to listen, he is setting himself up in opposition to the ‘steamroller’ Lansley.
‘We are not going to dictate what’s needed,’ says Dr Poulter. ‘We want to increase the profile of the work midwives do, and highlight that it is a great career. Leadership opportunities for midwives in the NHS are changing and increasing – there will be opportunities to influence clinical commissioning and to lead improvements to services so women have more choice and personalised care.’
Cathy Warwick, RCM chief executive, says: ‘The RCM is pleased to hear that the new health secretary has a keen interest in maternity services. We understand that he and his new ministerial team are committed to the maternity pledges made by the previous ministerial team.
‘We are also pleased to hear from Dan Poulter that there is interest in talking to the RCM about a minimum staffing standard for maternity services and we have written to Jeremy Hunt saying that, while we are delighted at the government’s decision to maintain student midwife numbers, we are very concerned that they are starting to find difficulty getting posts after qualification.’
With Mr Lansley having pushed through the reforms, is Jeremy Hunt the right person to oversee their implementation? Is a willingness to listen enough?
‘I think Lansley has a more instinctive feel for the NHS, for all his faults,’ admits Mr Burnham. ‘I don’t think Jeremy Hunt has that. When big, difficult issues arise, I don’t think people know which way he’s going to turn. I was tempted in my conference speech to say “come back Lansley, all is forgiven”, but I didn’t go that far. I think we need a safe pair of hands; someone who knows the department, and I don’t think Hunt ticks those boxes.’