Although Jeremy Hunt can be accused of many things, dissembling, incompetence and duplicity amongst them, it is my opinion that he actually works very hard. Unfortunately for us the aim of his efforts have not been improving the National Health Service but in managing the news to deflect the justified criticism of his actions and instead place the whole blame on the staff of the NHS or, incredibly, on us the users of the service Hunt is not looking for solutions to deep seated NHS difficulties, but rather to make HNS itself look unsalvageable. Here is how he is achieving this goal.
Missed targets are nothing new
This winter the NHS, especially its Accident and Emergency Departments are rarely out of the news. The main focus for the media has been the increasing inability to meet the target to treat 95% of A&E patients within 4 hours. The scale of the problem was leaked to the BBC last month. As a result Health Secretary Jeremy Hunt suggested that he may consider relaxing the four hour target.
The target has actually been missed for a long time (since July 2015, so not just a winter problem) and relaxing waiting time targets were actually authorised in the summer of 2016. The Mainstream media are reluctant to question the competence of NHS management or resourcing at the ministerial level. The reason is not hard to determine especially since it became clear that Hunt has a very close relationship with the Murdochs (owners of The Sun and The Times among other media outlets) as the scandal of the News Corporations attempted take over of BskyB conclusively proved.
Public service targets – a cold war idea of freedom, a modern day tyranny
But it is important to consider the way in which Hunt benefits from the ethos of public sector targets and the way they operate to isolate and demoralise public servants. The idea of public sector targets go back a long way to the Thatcher Government of the 1980s. For those activities of government which could not be privatised she adopted a radical new idea (developed by a cold war military strategist) of mimicking the free market using performance targets. State owned public services (including the NHS) would no longer run by ideas of public duty, but instead public servants were would be incentivized to improve efficiency by following their self-interest. As Adam Curtis pointed out in his documentary Fuck You Buddy (Part 1 of The Trap Trilogy):
They [Thatcher and her advisers] were liberating millions of public employees from the arrogant control of all the old elites. Instead, a new and objective method based on numbers set the targets which individuals were then free to achieve any way they wanted
As Curtis points out, it is a shrunken and limited type of liberation. Rather than an ethos of working for the community or public good, health provision is now based on calculating what actions are to the advantage of an individual unit in a number-driven system. Inevitably this has led to a feeling of isolation in health professionals and greatly reduced the motivation derived from the feeling of being part of something larger. The sense of isolation in a target based system is borne out in a study of NHS A&E nurses carried out, ironically, by the American based Emergency Medicine Journal. They found:
The consensus was that the target should be viewed as a hospital goal with a collaborative working strategy and a shared responsibility: “we’re all looking after the same people, and those people could be ourselves, our mums or children”
The desire for the target to be whole service is telling with the implied feeling of alienation from professional colleagues in other units in the hospital. The study also confirms the pressure on medical staff, reduced to cogs in a number crunching system, disincentivized to think about the greater good. No wonder morale struggles in an environment imposed by a squalid ideology based on a malignant distortion of libertarian theory!
The study also pointed to another major flaw in the target system. The collecting of statistics can become a substitute for a better understanding of the problems and the use of dubious targets results in progress in aims and measured effectiveness becoming detached from effective real world outcomes in terms of patient care.
Jeremy Hunt, peddler of failed ideologies or sordid salesman?
Hunt’s goal is to make it appear that failure to meet NHS targets is either the fault of the public, the fault of NHS staff in not employing best practice, or both. There may indeed be a problem with inappropriate use of A&E but there should be a well-thought out plan to deal with it, not a downgrading of targets. Solutions put forward by doctors for helping the public access suitable medical resources must be considered.
The fact that a combination of arbitrary targets (as pointed out in the American study) with ever greater pressures and fewer resources are fueling a sense of staff isolation is not seen as a problem for Jeremy Hunt and suits his aim of privatisation. The suggestion of easing the latest A&E four hour target makes him appear attentive and magnanimous, as though he is doing everything he can to save the NHS, before the inevitable sell off. Just as Mrs Thatcher saw the only way of ‘saving’ industries such as steel making was privatisation, Hunt is seizing the opportunity which an apparently ailing public service offers. But even Thatcher drew back from NHS privatisation. For all the damage to communities, however brutal the policies and however misguided the Thatcherite agenda has proved, it did at least have the defence that is hadn’t been tried before. Hunt has no such mitigation with the disastrous results of neoliberalism and privatisation clear for all to see. As either an ideologue peddling a failed ideology, a cheap profiteer making a quick buck for his friends, or as seems increasingly likely, both of those things, his trick is to fool us into thinking otherwise, I think he puts much effort into this task