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  • New priorities for the NHS will begin with bricks and mortar

    Matt Hancock may well have needed every watt of his ample refrigeration capacity to keep cool this week. But this wasn’t to do with the heatwave.

    On Wednesday, as he watched Theresa May’s Cabinet be unprecedently eviscerated one by one, did he wonder if his support for the new Prime Minister had been for nothing?

    A conversion to ‘Leave’, to the point of countenancing a ‘No Deal’, had not saved Jeremy Hunt from losing his prized job as Foreign Secretary. Would Matt Hancock’s support for ‘Remain’ in 2016 also make him ineligible for a place in a new, unequivocally ‘Brexiteer’ Cabinet.

    As the appointments were made, and faces old and new took their Cabinet places, it was confirmed.

    The Secretary for Health and Social Care, Rt Hon Matt Hancock MP, was staying. Does this stability amidst a whirlwind of change signal business as usual at the Department of Health and Social Care? I wouldn’t count on it.

    To understand what the new regime might mean for health policy, the best place to start is three days ago.

    Let’s take a step back

    When candidate Boris Johnson accepted the leadership of the Conservative and Unionist Party shortly after midday on Tuesday 23 July, his speech had one notable omission: the NHS.

    When the newly appointed Prime Minister, Johnson, stood in front of No.10 Downing Street shortly after 4pm on Wednesday 24 July, his speech still had one notable omission: a characteristic classical locution. But in that period of little over 28 hours, something had returned – health was back on the agenda.

    Boris Johnson’s first words as PM were notable for the detail in which he outlined an ambitious domestic agenda. Policing was there, education as well – following commitments during his campaign for party leader. And something else, figuratively and literally, was on the list:

    ‘we start work this week, with 20 new hospital upgrades’

    Sandwiched between commitments to address GP waiting times and to provide the money for NHS front-line services, this was a set-piece announcement. NHS England Chief Executive, Simon Stevens, has long made his feelings clear on the need for investment in the NHS’ infrastructure. He had previously described the transfer of capital funding to cover day-to-day spending, as “robbing Paul, to pay Paul”.

    The new PM was not done there, stating that:

    we will fix the crisis in social care once and for all’

    Picking up a political baton that had been dropped by Mrs May after an election to forget in 2017.

    In a later section of his speech Mr Johnson also named “life sciences” as the first in a list of strengths of the economy, before citing developments of the first gene therapy to treat blindness, specifically. He continued to say that he would champion biosciences free from anti-genetic modification regulations and tax changes to promote research.

    In saying all of this, the new PM – a man in a hurry – has made his priorities for his Health and Social Care Secretary clear: capital investment in the NHS; action on social care and a health research environment that provides an engine for the economy.

    So, what now?

    On taking the role one year ago, Mr Hancock said he had three priorities as Health & Social Care Secretary: prevention, workforce and technology.

    These are not the three priorities of the new PM. In fact, in the last year capital budgets have continued to be raided; delays to the Social Care Green paper are ongoing; and warnings about the impact of Brexit on UK research have been far-reaching, with a lack of certainty hampering investment and employment decisions.

    With a degree of clairvoyance perhaps, the speed in which a new course has been charted by Mr Hancock has been quite remarkable.

    Reports on Tuesday suggested that Mr Hancock had attempted to ‘bury’ the publication of the Prevention Green Paper, due to concerns around displeasing the incoming PM.

    On Wednesday, as eyes were fixed on those going in and out of No.10, a new lead was appointed to oversee the development of the NHS People Plan, but this was coupled with a cautious statement that suggested a plan would not be published this year as the Long Term Plan had anticipated.

    And though establishing the new NHSX sends a signal that technology will play a greater part in healthcare, its work so far has primarily been to dismantle major initiatives, like the ‘all singing, all dancing’ NHS app. With a new Chief Executive in place and his former technology adviser having made the move too, Mr Hancock will be confident that NHSX can be left without his hand on the tiller.

    And finally…

    So, what of the missing reference to Virgil, or Pericles, or something else from the Prime Minister’s famous rhetorical repertoire, when he spoke in front of the famous black door?

    Well, if the new PM couldn’t find the right quote from the annals of classical literature, perhaps he should have turned to his Health and Social Care Secretary who may just have been reading the words of Hannibal, who said on crossing the Alps, aut viam inveniam aut faciam – ‘I will either find a way, or make one’.

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