Zero by Jeremy Hunt review – this is going to hurt | Health, mind and body books
On a bitterly cold weekend in October 2015, the views of 20,000 junior doctors, freezing in our scrubs as we marched on Downing Street, were encapsulated in one unforgettable placard. “I may not be a gynaecologist,” it read, “but I know a Hunt when I see one.”
No other health secretary in NHS history has incensed the medical profession quite like its longest serving incumbent. During his six-year tenure from 2012 to 2018, Jeremy Hunt presided over a catastrophic decline in NHS standards, the pain of year-on-year austerity budgets, failed pledges to increase the size of the NHS workforce (those 5,000 extra GPs he vowed to deliver by 2020 shrivelled, in fact, into 1,425 fewer GPs) and, most infamously of all, a series of unprecedented strikes by NHS junior doctors.
As a striking junior doctor myself, anti-Hunt sentiment in my household reached such a fever pitch that my then three-year-old daughter, on seeing a tall man walking into the hospital where I worked, once shrieked: “Mummy! Jeremy Hunt is walking into your hospital.” “Oh dear,” I said. “What do you think I should do?” “Go in after him and chop off his head.” These were supercharged, horrible times.
Even today, six years after the dispute limped to an ignominious end (Hunt duly imposed his despised new contract), my casual mention in the doctors’ mess that he has written a book about, of all things, patient safety triggered a volley of anatomically robust invective. Zero, the new book in question, is subtitled Eliminating Preventable Harm and Tragedy in the NHS. Its ambition cannot be faulted: “Zero is a book about how the NHS can reduce the number of avoidable deaths to zero and in the process save money, reduce backlogs and improve working conditions,” Hunt writes. “Delivering the safest, highest quality care in the NHS post-pandemic could be our very own 1948 moment.”
If I read this correctly, Hunt is suggesting that his blueprint for the health service is so radical it may transform the provision of healthcare for the British public as dramatically as the inception of the NHS three-quarters of a century ago. Which raises a rather obvious question. Given that he was the longest serving health secretary in NHS history, why didn’t he impose his vision while in office, rather than waiting for the tumbleweed of the backbenches to write about it?
Hunt would argue he tried to do just that. Patient safety has been his mantra for years. Specifically, he writes, he wants to eliminate the 150 avoidable deaths that occur in the NHS every week. Unlike death from diseases such as cancer or heart disease, these arise from basic medical error. Fix the errors and “every single one of them is immediately preventable. We are not waiting for a miracle cure. They could be stopped right now if best practice were followed.”
Framed like that, it’s an arresting argument. Hunt elaborates. Historically, he explains, NHS culture has been opaque and evasive. When whistleblowers try to raise patient safety concerns, instead of listening to them, NHS trusts destroy them. In the worst cases – and Hunt describes numerous examples of neonatal deaths and failures of care in painstaking, heartrending detail – bereaved relatives can be left fighting for years as NHS institutions close ranks, covering up their wrongdoing. What is desperately required in healthcare, then, is a root-and-branch cultural overhaul. Above all, Hunt argues, we need candour, a no-blame culture and a sincere determination to treat every mistake as an opportunity to learn how to do better next time.
Disconcertingly, I entirely agree. More disconcertingly still, while researching this book, Hunt contacted me to ask if he could discuss where he’d gone wrong in the junior doctor dispute. To my surprise, he sat and actually listened, even when I told him that pretending to the public he could build a safer “seven-day NHS” without increasing doctor numbers was not only dishonest but “completely moronic”. Zero, it turns out, is a thoughtful, serious and well-written book that tackles an immensely important subject. On one level, Hunt is clearly moved by poor patient care. He describes repeatedly sitting with members of the public who share stories so grim they reduce him to tears. It is hard to imagine his successor, and infamous lockdown rule-breaker, Matt Hancock doing that.
But this is also the work of a consummate politician. The prose, in a word, is emollient. Hunt glides seductively over his track record in health, using omission and elision to rewrite history. He insists, for example, that just before leaving his post he successfully negotiated “the largest single [funding] increase in NHS history”. Although technically true (inflation alone means the size of the NHS budget rises annually), the five-year agreement for 3.4% annual funding increases failed to address the crippling impact of austerity budgets, didn’t even match the average, long-term NHS funding increase of 3.7% since 1948 and was criticised by the National Audit Office as being inadequate and unsustainable. While in office, Hunt oversaw the slowest period of investment in the NHS since its foundation, a fact he pointedly ignores.
What is most disappointing from a frontline perspective is Hunt’s failure to match his fine words on candour with action. I write as someone who this year has seen too many patients dying in misery to count. They’ve died on trolleys in the corridors of overwhelmed hospitals. Of cancers that should have been diagnosed months ago. In their own blood or excrement because the nurses are run ragged. In ambulances trapped outside jam-packed A&Es. The list goes on and on. Avoidable, ghastly, inexcusable deaths, the result not of medical error, but of a system so defunded and understaffed by the government that it is doomed to fall short of what patients deserve.
Political choices, in short, are causing avoidable deaths here, now, in every NHS hospital in the country. Hunt knows this yet chooses not to voice it. Presumably he still has one eye on Downing Street. And that’s the thing about candour. You can’t credibly advocate total transparency while dipping in and out of being candid when it suits you. A true patient safety champion would lead by example, speaking out about all kinds of patient harm, including those inflicted by their party in government.
Rachel Clarke is a palliative care doctor whose most recent book is Breathtaking: The UK’s Human Story of Covid (Little, Brown).