Hewitt Cautions Brown Against NHS Policy Change

Patricia Hewitt wrote to Gordon Brown on her final day as health secretary last week, criticising the NHS but advising against any changes in policy.

Leaked correspondence revealed yesterday that she said the NHS remained a “paternalistic” service which too often served the “tribal” interests of doctors and managers instead of patients’ needs.

In a letter seen by the Guardian, she called for changes in rules on competition between NHS hospitals to stop them undertaking “unnecessary work to protect their income”. She warned Mr Brown that he would cause despair throughout the NHS in England if he embarked on further reorganisation of health authorities and trusts. Ms Hewitt did not recant on any reform she had introduced since becoming health secretary in 2005.

Her letter appeared to have been crafted to persuade Mr Brown to adopt her approach on tackling unfinished business. If she succeeds, she may have tied the hands of her successor, Alan Johnson, who may want some freedom to win back support from doctors and nurses.

Signing the letter was one of Ms Hewitt’s last acts as health secretary. She was reporting the views of a national stakeholder forum of representatives from about 60 health organisations, including the medical royal colleges, managers, charities and unions. She said they wanted to “involve the customer” in the design and delivery of NHS care.

The service should learn from the public and commercial sectors about engaging with patients, carers and the wider public.

She wrote: “Forum members want, very much, to move away from a clinically paternalistic culture, but feel equally strongly that there is a long way to go.”

There should be better incentives to promote partnership between health and social services. At local level, “tribal loyalties and interests too often outweighed the goal of delivery”. She called for further changes in the system of payment by results, which encourages NHS and private hospitals to compete for patients. She said: “We need to fine-tune the tariff so that, while promoting efficiency in acute hospitals, it does not lead them to undertake unnecessary work to protect their income. This is easier said than done.”

Ms Hewitt said the Treasury should set public spending limits more than three years in advance to give providers enough financial certainty to build relationships and trust. “Three years isn’t long enough to see the results,” she said.

In a plea for stability, she added: “It is time for the Department of Health to stand back from too much policy innovation and allow learning and good practice to become embedded … across the country.”