As a former Health Secretary and Chancellor of the Exchequer, Jeremy Hunt has spoken out about his concerns for the National Health Service (NHS), should Andy Burnham, Greater Manchester Mayor, ascend to the premiership. In an impassioned argument for radical reform, Hunt believes that Burnham's experience in the health portfolio makes him uniquely positioned to transform the NHS from what he describes as the world's most bureaucratic health service into its most innovative.
Hunt highlights a worrying trend in NHS productivity. Despite a 20% increase in staff across NHS England since 2020, activity levels have only risen by 10%. This disparity has contributed to persistently high waiting lists, with much of the reported progress in reducing them attributed to 'list cleaning' rather than actual increases in patient care. The UK's government health spending as a proportion of GDP is among the highest in OECD economies, ranking fifth, and this inefficiency demands attention.
A key issue, according to Hunt, is the highly centralised nature of NHS England. He describes it as a system where 1.5 million people are micro-managed from London, burdened by 18 monthly operational targets for hospitals and 44 annual 'Quality and Outcomes Framework' (QOF) targets for GPs, which directly impact their income. This culture of constant target-setting stifles local innovation and fosters a sense of 'learned helplessness' among local managers, who are left with little time to develop productivity-boosting solutions.
To address this, Hunt proposes two major structural reforms. Firstly, he advocates for the complete abolition of national targets, a measure he himself wished to implement as Health Secretary. Secondly, he suggests devolving responsibility for the NHS in different areas to locally elected mayors across England, drawing inspiration from regional healthcare systems in Sweden and Denmark that operate universal healthcare with superior outcomes compared to the NHS. He also points to the success of the English state school system, which lacks national targets but grants high autonomy to heads.
Hunt believes that such devolution would allow local managers to tailor services to specific community needs, acknowledging that a hospital in Barrow-in-Furness faces different challenges from one in central London. While national standards, including maximum waiting times, should remain, Hunt argues for maximum autonomy in their delivery. He cites the example of 'Devo Manc' in 2016, where devolution to Manchester was intended but ultimately fell short due to the persistence of national targets and hospitals remaining accountable to NHS England, rather than the mayor.
Hunt concludes by suggesting that this moment presents an opportunity to complete the unfinished work of devolution, putting patients at the forefront of decision-making and allowing local areas to innovate and improve services tailored to their unique needs.