After a dramatic week in politics that nobody would have predicted, Matt Hancock, who had served as Secretary of State for Health and Social Care for almost three years was ousted from the department at the weekend. Replaced by Sajid Javid who was parachuted back into Boris Johnson’s cabinet on Saturday 26 June. However, with the world of healthcare policy moving at pace, Javid will have little time to get his feet under the table and set his priorities. In many ways, these priorities will be determined for him not by him, due to the circumstances of the healthcare landscape that he inherits. Below, we’ve outlined five key priorities that Javid will have no choice but to grasp in the weeks and months that come, and in some cases, in the next few days.
The pandemic and success of the vaccination programme
While issues and decisions swirl at the upper echelons healthcare policy, one undisputed political success for this government is the COVID-19 vaccination programme. An astonishing number of people have been vaccinated in the UK, with one jab or two, and this has cut hospitalisations and deaths to far more manageable levels than during any other time in the pandemic. That said, the battle is not over. Booster jabs in the Autumn and management of the pandemic through the Winter and Spring will be paramount to keeping this government stable. Any derailing of this programme could have serious consequences for this government. And Javid is the new face of COVID-19 vaccinations, whether he likes it or not.
The Health and Social Care Bill
The Bill – first expected to be published this week, but now delayed (for how long is still unknown) – ushers in a major reshuffle of the planning and management of health and care in this country. This is no small task during a major pandemic and personnel changes at the top (in NHS England as well as in government) only serves to raise more questions about the process we all thought would be relatively straightforward. Any delay to the publication of the Bill may mean implementation will be tricky. ICSs are due to become statutory by April 2022, but will that be feasible if the legislation is continually delayed? If we look to April 2023, what impact could that have on an upcoming general election?
Javid will need time to get to grips with the Bill, and without any political or operational sponsors (with Hancock and Simon Stevens out of the equation, and reported concerns in No 10), there is now the possibility that the Bill changes in any number of ways.
The NHS backlog
One of the major – and very real – issues facing the health system is the huge backlog of diagnoses and treatments that continues to expand at an alarming rate, most acutely as a result of the pandemic. Some reports suggest waiting lists are increasing by 50,000 a week and it will not be long before this becomes a major political and public issue. The Bill, the pandemic, and the wider reforms and funding landscape will all have a dramatic impact on meeting this challenge and Javid will want to act fast to prevent it becoming uncontrollable.
Simon Stevens’ departure and appointing a new Chief Executive of NHS England
Change at the top – during some of the biggest health challenges facing our country in decades – always brings uncertainty and instability. That a Secretary of State can depart during the same period that a Chief Executive of NHS England departs will be an acute challenge. Some of the names touted for the top job – the likes of Dido Harding – could bring significant scrutiny to Javid and No 10. Undoubtedly. Javid and Boris Johnson will look to appoint someone operational, someone politically uncontroversial – indeed, mostly unknown – and someone who can be close to the centre as it looks to consolidate power. This appointment is no small decision and has the potential to affect all the other priorities on Javid’s list, so getting it right will be crucial for him.
Social care has been the perennial problem for governments for many years now. Nobody wants to tackle it because there is little political benefit in doing so. It’s complicated, expensive and the incentives are unfavourable. Sajid Javid may bring his knowledge of the Treasury and friendship with Rishi Sunak to this problem to find a real solution that delivers for the country. More likely, however, is a stopgap solution that kicks the can further down the road – such as a cap. It will not solve the problem, will not improve services, but could deliver (in a roundabout way) the Government’s commitment to act. Javid will have to act quickly if he is going to act at all, as the Spending Review will come around quickly, and the negotiations (with potential trade-offs) will be long.
These are just a handful of issues that the government faces. There are many more – from public health reform to workforce challenges – the in-tray in Javid’s office will be overflowing. If you would be interested in hearing more on any of these issues, or indeed believe other priorities should make their way onto this list, do get in touch with firstname.lastname@example.org and we can setup a call to discuss further.