Jeremy Hunt’s decision to bring in former Labour MP and cabinet minister Patricia Hewitt to help his government ‘reform’ the NHS has brought her record as health secretary from 2005-7 sharply back into focus.

While the press release accompanying the move – described as a “review of how integrated care systems can best be empowered and supported to succeed” – omits all mention of Hewitt’s past political affiliation, some of the ‘trigger’ terms included (like “cutting through red-tape” and “enhancing patient choice”) strongly hint at the policies once enthusiastically embraced by the Blair appointee during her time in office. 

What is an integrated care system?

Hewitt’s record at the Department of Health & Social Security (as it was then known) – skated over by some sections of the media, but revisited  – wasn’t entirely without merit, as she was responsible for pushing through the ban on smoking in public places. That move saw hospital admissions for heart attacks fall by 2.4 per cent immediately, the equivalent of 1,200 heart attacks a year.

But it was her stance on commercial interests being given a greater role in the health service that caused most concern while she was health secretary, a stance which may yet resurface in her latest role. 

Shortly after taking up the health secretary post in 2005, Hewitt invited private tenders for a round of ‘independent sector treatment centres’, worth around £500m a year, but excluded NHS hospitals from the bidding process. Publicly-owned NHS treatment centres, meanwhile, were deemed likely to be handed over to private operators. 

Around £400m-worth of scans, blood and pathology tests were also to be hived off, all part of plans to double the volume of private sector work purchased by the NHS, with at least 10 per cent of elective operations handed over to the independents.

These and other proposals naturally proved controversial, and in November that year, in a speech to community health chiefs at the NHS Alliance annual conference, Hewitt had to apologise for publishing plans which would have forced primary care trusts (PCTs) to contract out all district nursing, family planning clinics and other local health services. She also had to reassure delegates that a forthcoming white paper would water down proposals to create competition between NHS GPs and private clinics across England. 

Such contrition proved short-lived, however, as the following January saw the launch of a white paper which sought to push PCTs to outsource all services. Hewitt went on to tell a press briefing that there was “widespread enthusiasm” among staff to leave the NHS and work for social enterprises instead. And later in 2006, private insurance companies were invited to bid for a large slice of the £64bn NHS commissioning budget then controlled by PCTs, and public sector procurement body NHS Logistics was carved up in order to award a contract to Texas-based Novation. 

Competence issues also arose during Hewitt’s tenure at the DHSS. She oversaw the introduction in 2007 of the MTAS, a computerised job application system for junior doctors which, because of security issues, led to personal details – phone numbers, home addresses and sexual orientation – becoming publicly available. Hewitt was forced to apologise for the “needless anxiety and distress” that the move had caused.

Back in 2008, while still an MP, Hewitt may have benefited from her time as health secretary when she was offered consultancy roles with both Cinven, a private equity company that had just bought up BUPA’s UK hospitals for £14bn, and pharmacy chain Alliance Boots. One newspaper report at the time suggested these two roles would have netted her at least £100,000 a year.

Then, two years later, a Channel 4 Dispatches investigation into political lobbying claimed that Hewitt had appeared to suggest she was being paid £3,000 a day to help a client get a seat on a government advisory group. That allegation led to her being suspended from the Labour Party.

What does the review signify?

(Paul Evans)

As for Hewitt’s brief to review the workings of the brand new integrated Care systems there is little detail apart from headline promises

“The government has announced a new independent review into oversight of ICSs to reduce disparities and improve health outcomes across the country.”

Which apparently includes giving ICSs,

“greater control and making them more accountable for performance and spending, reducing the number of national targets, enhancing patient choice and making the healthcare system more transparent.”

It is doubtful that the government intends to make the ICSs more accountable to the public, for they are certainly more remote and no more transparent than the Clinical Commissioning Groups they replaced. More likely are further restrictions on Integrated Care Boards to stick to their budget despite the horrible compromises that they will face from the fresh squeeze on funding. 

Nobody wants to see public money wasted but this kind of review reinforces the fantasy that there is a rich seam of efficiencies that can be made in a system that outperformed the wider economy in terms of productivity improvement before the pandemic, and which has year on year been forced to carve out savings during long periods of underfunding over the last decade. There are ways to work smarter, improve connectedness between services, and employ new technology, but these require time, space and money to bring them online. They are not a replacement for a realistic plan to raise staffing levels.

“Patient choice” has traditionally translated into the wider involvement of independent providers. Beyond that it is hard to see how a system which is so low on capacity can offer more than words on issues like choice, most patients would opt for the earliest appointment date possible and patients are already travelling to find the care that they need.

“Local flexibility and freedom from national targets” on the other hand may well have some appeal for NHS managers beset with demands from all sides, but what it means in policy terms is completely unclear. 

So what is the purpose of the Hewitt review? – Early indications are that it is far from a serious attempt at meaningful support and improvement, more likely is that it serves as a distraction from the neglectful reality of the recent financial statement, that even now, the NHS still lacks a fully funded plan to steer it out of the crisis. 


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