Even in the best of cases, being secretary of state for health and welfare is one of the most popular positions in government. Historically, the role has generally been defined by the approach of the NHS: to calm it in periods of conflict or interrupt it with major reform.
Advice from predecessors when starting work include “Buy time … publish a 10-year plan” (Alan Milburn); “Think it over” (Frank Dobson); and “don’t make big speeches for at least a month … find out exactly what’s going on” (Alan Johnson). But for newbie Sajid Javid, time is short as the inbox is already bulging.
The first is to successfully manage what is hopefully the final stage of the pandemic. Javid’s apparent preference for relying on individual responsibility over imposed restrictions may put him at odds with scientists advising the government. Beyond these immediate decisions, you will need to manage the vaccine launch and a likely fall booster program, working in collaboration with the Department of Health and Social Care, NHS England and other public agencies.
In particular, it also means rapidly developing an effective relationship with whoever is the new CEO of NHS England and their board. The NHS is unlike any other body overseen by a government department; It is the UK’s largest employer and industry, a top concern of the public and always in the news.
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Then, successfully administer an NHS bill, inherited from Matt Hancock, which is due to start its way through parliament. The bill has two main parts: the first would allow planned changes in the organization of health and social care to take place in April 2022; the second to give the secretary of state more powers over the NHS.
The first has widespread support, the second is highly controversial. To make the bill easier to pass, Javid should get rid of the second one. You could put your own stamp on the invoice by adding extra provisions, recommended by Jeremy Hunt and the Health Selection Committee, to improve workforce planning in health and social care.
Then fix the delay in care. The number of people in England now waiting for routine surgery has surpassed 5 million, the highest since records began, with more than 400,000 waiting for a year. Javid will know that governments are hurt by long waiting lists and should be seen to address this seriously. Only radical intervention will work, not business as usual.
The NHS had spectacular success with New Labor’s ‘war on waiting’ in the early 2000s. The recipe? Investment in personnel and infrastructure, with central support and objectives. If investment is tight, the over 100,000 shortage workforce is even more of a bloc, and wage disputes threaten.
If Javid is willing to keep the bag strings tight, then he might reflect on Brian Cox’s observation: that you don’t have to believe in gravity, but you will fall to the ground anyway.
Then social care. Given the explicit promise of the prime minister to present plans by the end of 2021, the repair of social care can no longer be circumvented. A solution means a cap on the costs of social care that people bear (the so-called Dilnot ‘cap’), which can be done tomorrow as it is already in the statute book but not enacted (since 2014).
But a solution also means expanding social care to more people who have very important needs, but who do not currently qualify for support. Our analysis published this week shows that people living in the old Red Wall seats have the most to gain from a cap on social care costs. Implementing a cap, as well as broader welfare reform, would cement his reputation across government and with newer conservative voters.
Then cheers. The broader factors affect the health of the population much more than care; housing, poverty, early childhood support, poor quality work, air quality. We know that life expectancy has stagnated in Britain more over the last decade than anywhere else in Europe, and the health gap between the best and the worst has widened.
In Hartlepool, children born today can expect to live 57 years in good health; in Richmond-upon-Thames 71 years. In the areas of England with the lowest healthy life expectancy, more than a third of people aged 25 to 64 are economically inactive due to long-term illness or disability. Aside from the human cost, this comes at a financial cost and is avoidable.
The central government, until now, has been quite on the sidelines of this agenda, with prevention strategies that focus on individual agency and technology, without influencing the so-called broader determinants of health.
Javid should show leadership and make a real difference here, link health with leveling strategy, which to date has focused on infrastructure, and develop an intergovernmental strategy to improve health, all with consistent metrics.
Another of Javid’s predecessors as a health secretary, Virginia Bottomley, observed that on paper you were a “glazier or window breaker,” which depended more on context than personal style. Given the devastating blow of the pandemic to health, the NHS and social care, the times demand that Javid be a smart glazier. Let’s see.