Throwing away an important announcement – some communication problems for the Secretary of State for Health
Filed Under (Narrative of reform, Secretary of State) by Paul on 03-12-2012
I, along with many commentators, felt that Jeremy Hunt had been made Secretary of State for Health because he was good at developing a strategic and tactical approach to communicating the Government’s message.
His predecessor failed as a reforming Secretary of State because he could not communicate to either the public or the NHS what problem his reforms were meant to solve. He was also silent on the subject of how they were going to solve it.
All he did was to use up a great deal of Coalition Government political capital by, at one stage, leaving the majority of the population believing that he had a secret plan to privatise the NHS.
He also managed, and with hindsight this is his staggering accomplishment, to LOSE the argument that politics should be removed from the NHS. By the time he left office the majority of people wanted a politician, the Secretary of State, (even that Secretary of State) to be accountable for the NHS.
For this, as for so many other things, I am grateful for his failure to communicate.
This is a difficult mess for the new Secretary of State to clear up. In terms of public debate he has been told to take the heat out of the row about the NHS – and at the same time he has to implement a reform programme that is based upon something being severely wrong with it.
So in effect he has to say, “We think the NHS is wonderful but we are also carrying out a programme to change everything about it”.
This is possible – but not easy.
He started badly. He managed to hijack his own first interview with the Times in the opening weekend of the Conservative Party conference with a statement about reducing the time in which legal abortions could be performed. He compounded this error, which is after all an issue about which we know different politicians have different thoughts, by saying that this was based on scientific evidence. This was a challenge to the hundreds of medics who disagreed with him on abortions. A challenge they picked up by quoting the science back at him for hours and days after his interview.
This mistake blew the first weekend of the conference apart and led, I am sure, to a sharp interchange with his boss the Prime Minister.
Then he was on the TV early one Friday morning arguing for the rolling out of revalidation of doctors. This is not a difficult policy to explain. In fact the BBC did it for him by using the populist analogy of doctors needing an MOT. In the interview he seemed very ill at ease and was not able to clearly say that, “Yes there are some bad doctors, and it is in the public interest to use revalidation to improve or remove them.”
His problem is he has been told not to generate a single headline with the phrase “nurses or doctors are angry” in it.
This restriction has caused to look scared when explaining what he is trying to do.
Then, last Wednesday, he made an interesting and important speech about caring and compassion.
The speech quite rightly identified that sometimes, in some institutions, a culture of neglect can develop – and that we need not only to be aware of this but work hard to understand how it happens.
He then went on to say that the public need a clearer set of indicators to be published by the CQC. This is an important point for public accountability. But, and here is where he detracts from his message, he does not want to go back to the star ratings.
So he wants a set of easy ratings but they mustn’t have stars. This confuses the message. He ends up not telling us what he wants but what he doesn’t want.
If he had said that we want to go back to star ratings the speech and the intention would have got a lot of publicity.
The analogy that the Secretary of State used was with Ofsted. Ofsted provides a very easy and understandable label for schools which parents and pupils can use to make judgements.
Most professional organisations in education don’t like this, but it is very useful for the public.
Is the Secretary of State for Education worried about what education professionals say about him? Not at all.
He has an organisational and political strategy which that has constructed clear and speedy reform. The strategy is simple. He says that Blair was in favour of academies and argued for them and that Brown was against them. This has resulted in his reform policy for academies receiving support from within one strain of Labour politics.
This has resulted in his reforms going further faster than those in health.
How would this argument be organised for a more confident and capable Secretary of State for Health?
1 In 2000 all major NHS organisations signed up to the NHS Plan
2 The NHS plan said there would be rankings of NHS providers – I think as a ‘traffic light’ proposal.
3 This was a very important part of public accountability for public services.
4 The winning 2001Labour Manifesto said they would implement the NHS plan.
5 In September 2001 the Government published star ratings for all NHS secondary and mental health care providers.
6 They continued this and based the right to become an FT on having three stars.
7 Later the Healthcare Commission decided to drop these ratings.
He could therefore say “I agree with the public accountability of the NHS plan and with the Blair Government and I disagree with the lack of public accountability of dropping these ratings.”
This is what Michael Gove would have done and, as with everything else when compared with health reform, he would have got much further much faster.
But this would have led to some conflict with professional organisations and would need him to see beyond May 2010 being year zero for health service reform.
I am beginning to think that Jeremy Hunt is not as good at communication as I believed him to be…