Sajid Javid had been in post for eight days before he introduced the most significant piece of healthcare legislation for over a decade. A large part of the rationale for his appointment was based on his experience of running a big department rather than his policy background. Mr Javid has said very little on healthcare policy or the NHS during his time in Parliament, so it is hard to understand what direction he will take his stewardship of the NHS in. There are, however, a number of critical issues he needs to address quickly.
The Health and Care Bill
The legislation that will put in place the legal and structural framework for the future of the NHS. Communicating this to his own MPs, the 1.2 million people working in the NHS and the public will be pivotal to the smooth passage of this Bill. There are already storms brewing, changes to procurement rules are always contentious, the experiences and negative headlines of the last 12 months will only make this even more controversial. The Labour party is already on the attack and will use this as an opportunity to highlight the so called ‘chumocracy’ at the heart of Government. The Bill, in its current form, is the draft the Matt Hancock would have put down if still in post. Hancock’s experience of the last 18 months has led him to seek ways to take more control over the NHS, to give him the powers that would allow him to intervene directly in certain circumstance and give the Secretary of State more say in the running of the service. One of the guiding principles of Andrew Lansley’s Bill a decade ago was to ‘take the politics out of the day to day running of the NHS’ then this new Bill is aiming to reverse that put the politics right back at the centre. Initial noises from Javid’s office suggest he doesn’t share Hancock’s vision and would prefer to take a more arm’s length approach and keep the management of the NHS within NHS England. Mr Javid now faces the task of shepherding the Bill through Parliament and establishing exactly what role he thinks the Secretary of State should have in the management of the NHS. A tough job for anyone, let alone someone with a week’s experience.
The NHS Chief Executive
Simon Stevens was elevated to the House of Lords this week as his time at the top of the NHS comes to a close. Mr Stevens did not always enamour himself to the Tory benches. Many Conservative MPs saw him as too combative with Ministers and felt frustrated at NHS England’s approach to communication with MPs and Parliament – which can be best described as somewhat opaque. Mr Javid now has the challenge of finding his replacement. Plenty of names remain in the fray – Jim Mackey (does he want it? Apparently not shortlisted), Amanda Pritchard (not political enough, too much of an apparatchik), Mark Britnell (too long out the service, a management consultant, too much like Simon Stevens?), Dido Harding (yeah, probably not), Samantha Jones (too political for the NHS to welcome), Douglas Gurr (not sure appointing the former head of Amazon UK send the right signal). Mr Javid needs to get this one right, he needs someone that will shape the new service during a time of challenge and upheaval. Whoever is appointed needs to be able to galvanise the workforce and deliver real results, quickly.
The 1% pay rise for NHS staff. ‘Abysmal’, ‘insulting’, ‘pitiful’ – just some of the adjectives used to describe this. Conservative MPs have already been grumbling, aware of the impact this pay rise will have on their inbox if this goes through. From his time at the Treasury, Mr Javid will be aware of the challenges of balancing the books and delivering what is required politically. Mr Javid certainly took a more political approach than his predecessor at number 11 Downing Street and he will be acutely aware of the impact the 1% pay rise will have on NHS staff and the perception of the Conservatives by the general public. The challenge will be whether he can convince his successor at No.11 to open up the coffers and fund a bigger increase.
Mr Javid’s opening gambit as health secretary was to support the relaxation of lockdown rules, highlighting the impact on wider non-covid related conditions. There is no question that he is acutely aware of the number of people waiting for treatment and the challenges of reducing the ever increasing waiting lists. A tired, demoralised NHS work force will now be asked to work even harder to carry out the elective treatments required. This will require a gargantuan effort and will take a lot of time and lot of funding. Mr Javid will have to think creatively about how he addresses this and how he communicates the challenges to both the public and the NHS. The Conservatives have been in power for over a decade, the lack of capacity in the system was there prior to Covid. Mr Javid now faces the challenge of increasing that capacity and keeping the public on board.
With no General Elections imminent (hopefully), Mr Javid does have a little bit of time to create a positive feeling about the running of the NHS. The Labour party will want to focus on the issues related to healthcare, not least the millions of people now waiting for treatment. Turning this into a good news story for the Conservatives is probably going to be the biggest challenge of all for Mr Javid.