Editorial Wednesday 9 September 2015: Jeremy Hunt goes Full Stevens with bid to abolish/universalise FT status

I have previously mentioned that NHS England Sun King Simon Stevens has a way with legislation that doesn't suit his strategy: he simply ignores the shit out of it, in the sure and certain faith that he won't be challenged.

The traumatic legacy of the 2012 legislation is such that PM David Cameron and Chancellor George Osborne want to re-onshore health policy from Simon as much as they want a return to recession.

(I was in fact the first person publicly to point out Simon's 'sod what the legislation says' tendency).

This morning marks the third year of Jeremy 'Bellflinger' Hunt's tenure as Secretary Of State For Health. Mr Hunt hasn't been too bad overall, and he marked the occasion with a genuinely interesting interview with HSJ's Crispin Dowler.

Going Full Stevens
Mr Hunt has gone Full Simon Stevens, with his proposal that CQC 'good' or 'outstanding' rating should be the new measure of NHS success, and could see legislative change to have this replace authorisation as an FT by The Artist Formerly Known As Monitor.

Mr Hunt wants high CQC ratings to become the NHS provider sector's "single definition of success”.

This change would, I think, require primary legislation to amend the provisions in the 2003, 2006 and 2012 Health And Social Care Acts. Monitor's function is outlined in some detail in the statute, and orders in council will not be sufficient to amend this. It'll take primary legisation.

In the HSJ interview! Mr Hunt told Dowler he was "not persuaded” legislation was needed, as he thought "we can probably streamline the processes so that we’re able to… turn ‘good’ or ‘outstanding’ trusts into FTs fairly promptly”.

It's a point of view ... but it's not what the legislation says.

One definition of good
This is not the only issue. If a CQC good or outstanding rating grants FT status or freedoms, then what happens if the next year's CQC report finds a deterioration?

This sounds like making the autonomous self-directed quality focus of standalone providers much more conditional. And like a recipe for further instability for chief executives, and decreased attractiveness of their jobs.

It is also more than slightly opaque what would be the fate of non-good-rated non-FTs. The fate of non-FTs such as Hinchingbrooke and South London Healthcare Trust, and indeed FTs such as Mid-Staffordshire , can scarcely fill us with hope that there is a robust system to deal with provider failure, which will follow inevitably from such judgments.

Fail better
Dealing with failure will be the acknowledged top priority of NHS Improvement's inaugural chief executive, who will be receiving a hospital pass of epic magnitude. (Their unacknowledged top priority willl be trying to prevent the money being blown up: this can't be done, not this financial year. Last year's overspend level will be breached, with consequences for civil servants' careers. And perhaps ministers', too.)

Whether the end game is to abolish or universalise FT status and freedoms, the aim here is to underline the sidelining of Monitor. This makes clearer sense of the decision to give CQC a role in assessing use of resources.

A concluding observation is that this serves as a valedictory stab in the front for Monitor's outgoing chief executive Dr David Bennett from Mr Hunt.