On one issue about the NHS, Jeremy Hunt is proper | Steve Richards

‘Jeremy Hunt’s interventions had been wholly understandable and deserve support. If there is an A&ampE calamity this winter it is his neck on the line.’ Photograph: Neil Hall/PA

Picture the nerve-shredding shock for hospital bosses who failed to meet their targets for accident-and-emergency provision. One day in the direction of the end of final year their phones rang and it was the overall health secretary, Jeremy Hunt, asking them what had gone wrong. There is typically a mountain of mediating bodies separating hospital bosses from Hunt, but there he was on the telephone telling them diplomatically to raise their game. This act of hyper-active diplomacy marks the biggest U-turn of the coalition and explains the noisy eruption of NHS-related stories at the start of the new 12 months.

For decades governments have sought with a naive evangelism to move away from Aneurin Bevan’s principle that if a bedpan dropped in a hospital corridor the reverberations must echo in Whitehall. The Conservative wing of the coalition had meant to make a revolutionary leap away from the principle. Prior to the final election I attended meetings in which the then shadow cabinet and external professionals discussed how to devolve energy as far away as possible from Whitehall to personal customers of solutions. In fairness to Andrew Lansley, then the shadow health secretary, he was fairly open about his objectives. When some thing went wrong in an person hospital or a local location he must not be appearing on the Today programme due to the fact responsibility would lie elsewhere. Other frontbenchers were equally clear. They had been going to move the levers away from Whitehall. When a bedpan dropped it would not be a matter for them.

If at these genuinely exploratory and thoughtful meetings they had been advised that a Tory overall health secretary would be phoning personal hospital bosses from Whitehall they would have all necessary urgent medical consideration.

Hunt’s cellphone calls frame one of many clashes between the well being secretary and those who think they must be operating the NHS. Shortly ahead of Christmas, Sir Malcolm Grant, the chair of NHS England also complained that Hunt was striving to micro-control. Grant advised the Observer that politicians ought to end meddling in the NHS at a time when clinicians had been supposed to be in charge. From his division in Whitehall, Hunt was taking a keen curiosity, also keen according to the mighty quango, NHS England. In both circumstances Hunt’s interventions have been wholly understandable and deserve support. If there is an A&ampE calamity this winter it is his neck, along with David Cameron’s, that is on the line, much a lot more than those of the hospital bosses or the largely anonymous figures at NHS England.

If a huge services is presented cost-free at the stage of use, paid for completely by taxpayers’ income raised centrally with the degree of investing also determined centrally, there is no way close to it. The elected overall health secretary has at least a degree of accountability and a substantial degree of accountability when a bedpan rattles.

But, despite the fact that Hunt’s assiduous focus is reassuring, it heightens the level of chaotic confusion as to who is responsible for what in the NHS. The government can’t simultaneously create a framework in which it seeks no longer to be immediately responsible for provision, dismiss the so-referred to as “target culture” and then commence phoning individual hospitals demanding that they meet targets.

The messy ambiguity is at the heart of each debate on the NHS. This week the Guardian published a letter from ten NHS organisations asking for significantly less focus on the adverse aspects of the NHS, implying that Hunt has used scandals this kind of as these at Mid Staffordshire to paint an unnecessarily bleak picture. Again this is not honest on Hunt who had each and every lead to to react lengthily and extensively to scandals that raised wider issues. But the bewilderment from the army of NHS organisations is understandable in the sense that they have been informed repeatedly they would be allowed to get on with running the wellness service with out interference from ministers.

The exact same confusion applies a lot more overtly in an interview provided this week by Dr Clifford Mann, president of the School of Emergency Medication, complaining that ministers had ignored warnings about an A&ampE crisis as they were “tied in knots” implementing their original contradictoryNHS changes. Mann captures the inevitable chaos of the early attempts by coalition ministers to devolve power and now their desperate attempts to assert control.

In this column I refer to Hunt, NHS England, the Care High quality Commission and ten separate NHS organisations. I have hardly scratched the surface. There are as well many institutions accountable for the NHS, with no one particular realizing very who is accountable for what. But at least we have some clarity. Ultimately and rightly the elected health secretary is accountable. Hunt’s mobile phone calls symbolise the finish of the fantasy, begun by New Labour, that taxpayers ought to fund the NHS and then have no mechanism to hold the government to account for the subsequent delivery of healthcare.

On one issue about the NHS, Jeremy Hunt is proper | Steve Richards