Jeremy Hunt cannot bully his seven-day NHS plans through

The Guardian’s revelation of the Department of Health’s analysis of the risks around seven-day working exposes how a highly political health secretary is meeting his nemesis in the hard graft of policy implementation.

There is nothing remarkable about the existence of a risk register; identifying a range of potentially serious problems is standard practice for any government policy. What is striking is that 13 major risks are rated red or red/amber – meaning they are very likely or likely to occur.

Translating Whitehall-speak into plain English, the document tells us that ministers are not sure what they are trying to achieve, that in all likelihood seven-day working will make little difference to hospital services, that there is little agreement on how it should be delivered, plans that do exist are of poor quality, and there are not enough NHS staff in place to make it all happen.

In short, this is a policy – and a health secretary – in crisis. Jeremy Hunt has been trying to batter seven-day working through by winning the propaganda war with the junior doctors over the introduction of new contracts, and doing so by misrepresenting the evidence. Listening to Hunt, the casual observer would assume that the only thing standing between today’s NHS and effective seven-day working is changing doctors’ shift patterns. This document reveals far more serious obstacles.

It is obvious that Hunt is ignoring advice from his civil servants on the most fundamental aspects of delivering a massive and complex policy. The document states baldly that “the objectives and scope are not fully agreed upon, but delivery has started”. In other words, Hunt has been willing to risk strikes by doctors without being clear what he is trying to achieve.

It appears he has not even established a clear position with Downing Street; the risk that the policy does not meet the expectations of No 10 is rated red – an extraordinary position for such a controversial course of action.

Perhaps the most damning revelation is that Department of Health civil servants endorse one of the major criticisms of Hunt’s seven-day working push – that there are simply not enough staff with the right skills to do it. Again, this risk is rated red. Even with generous funding, the timescales around NHS workforce recruitment, training and deployment are such that it would take years for full seven-day working to be implemented, yet Hunt persists in creating the impression that the only obstacle is the lack of will among NHS staff to do it.

Hunt has also ignored civil service advice on how he has pitched the case for seven-day working to the public. In another document obtained by the Guardian and Channel 4, officials have told him that his repeated allegation of patient safety failings at weekends “has not been helpful”. They have been pushing him to explain the benefits for patients, pointing out that attempting to play on fears of medical accidents is not winning public support.

In his early months as health secretary Hunt demonstrated the skills of a political Houdini. The coalition government had been under fire for months over Andrew Lansley’s botched health reforms, but his replacement was able to distract the public’s attention from the chaotic and expensive changes and take the fight over the NHS to Labour by using the Mid Staffordshire scandal to shift the spotlight to quality and safety.

But eventually, rhetorical flourishes have to give way to the long-haul of planning and implementing change, and this is where Hunt’s tenure as health secretary is starting to unravel. Having scored a success by picking a fight with Labour over Mid Staffs he believed he could chalk up another victory by winning a confrontation with the British Medical Association.

But his officials are trying to tell him that changing the junior doctors’ contract is just a small part of implementing seven-day working across the NHS. Hunt needs to listen to civil service advice by reframing the policy around the benefits for patients, being clear on the objectives, adopting a realistic timescale for implementation and above all securing adequate funding. It is simply not possible to bully this policy through.

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Jeremy Hunt cannot bully his seven-day NHS plans through