Hancock has left the NHS in crisis. Don't assume Javid will save it | Andy Cowper

Credit to Matt Hancock where it’s due. Overtaking Andrew Lansley to become the 21st century’s worst UK health secretary was no mean feat, but he managed it. Hancock’s record and ignominious exit from an ignominious tenure put him in pole position in the Academy of Useless Ministers.

Everyone has private lives, but Hancock’s affair with Gina Coladangelo became a public interest issue because he appointed her to the health department’s board, on a reported £15,000 salary for a few days’ work a year. This breaches pretty much all of the Nolan standards of public life, and drives a horse and cart through the ministerial code.

Then, on top of the hypocrisy of breaking his own social distancing rules, is his track record as health secretary. This would have been unimpressive in normal times, but during a health crisis it was atrocious. PPE procurement shortages; the care home scandal: we now know that even the prime minister considered Hancock’s performance “totally fucking hopeless”.

It was Hancock’s decision to set up the test-and-trace programme last year on a centralised and outsourced basis, with no penalty clauses for poor performance.

Much blame for the programme’s failure was dumped on Dido Harding, who took over running it in May 2020 (and who now aspires to be the chief executive of NHS England). But test and trace was a Hancock creation.

The government’s one big success has been the vaccination programme: for this, credit is due mainly to Kate Bingham’s leadership of the vaccines taskforce, for the procurement; and to NHS England’s Emily Lawson for the NHS-run planning and rollout (she’s now joining the No 10 delivery unit).

NHS staff had been working in appalling conditions in vastly overcrowded Covid units with a lack of PPE, during which time hundreds of health workers died, but Hancock insisted that the government’s offer of a meagre 1% salary increase was a “pay rise”, despite inflation running at 1.5%.

And then there’s Hancock’s imprint on the forthcoming health bill. The government, traumatised by the political fallout from the Lansley reforms that created the 2012 Health And Social Care Act (whose story is brilliantly told here), has for almost a decade outsourced health policymaking wholesale to the head of NHS England, Simon Stevens, who leaves at the end of July. These NHS-requested reforms largely euthanised the least effective aspects of the Lansley reforms.

However, when I obtained and published the bill white paper back in February, the first thing I noticed was that Matt Hancock had looked at the NHS reform proposals, and decided that they needed more Matt Hancock.

He has made dramatic additions that greatly increase what would have been his power. Specifically, the health secretary gets new powers to intervene at any point of an NHS reconfiguration process; to transfer functions to and from specified arm’s-length bodies, and the power to abolish those bodies. He also gets the ability to mandate NHS England to take on public health functions (which had been transferred to local government in the 2012 Act).

And Hancock leaves NHS England with an underlying deficit; a £9bn capital and maintenance backlog; a high and longstanding level of staff vacancies; and a backlog of more than 5 million people waiting for treatment for the first time in the NHS’s history.

What does all this mean for the NHS more broadly? The service went through major upheaval during the pandemic, keeping open as many services as it could, as well as scaling up critical care for those hospitalised with Covid-19. But those who were dissuaded or fearful of accessing healthcare during the peaks of the pandemic are now starting to come back. Rough estimates indicate that demand is increasing by about one-third over the usual level.

That demand is coming back into a system in which many staff are exhausted, stressed and in some cases traumatised by what they saw during the pandemic: patients dying alone; the deaths of colleagues. This comes on top of NHS staff’s longstanding experience of having to manage gaps in the workforce, which is clearly draining.

The NHS backlog was already bad before Covid: independent analysis from 2020 shows that, even pre-pandemic, the NHS would have needed to treat an extra 500,000 patients a year for four years to get back to its standard of 18-week maximum waits for hospital care.

Covid has made this much worse. As the Health Foundation states: “Without a radical intervention to increase capacity, it is unrealistic to expect the 18-week standard can be achieved by 2024 with current infrastructure and staffing levels.”

The broader context is that the NHS has gone through a period of the lowest sustained funding growth in its history. Further analysis by the Health Foundation shows that from 2015 to 2019, NHS funding grew by 1.6% a year: well under half the historical average.

There is also the massive unresolved issue of social care. Our current system simply means that, without proper community support with living, dressing, washing and eating, vulnerable people’s health deteriorates so much that they need hospitalisation. And because they need this support, they are often stuck in hospital until it is available or until arguments over its funding are resolved.

The incoming health secretary, Sajid Javid, will now be confronted by the real consequences of the austerity policies that he consistently supported. Increasing NHS funding may not instinctively appeal to him. Equally, going into the next general election with long NHS waiting times is unlikely to be a good move. Fixing the problems facing the NHS is not only about the money, but a great deal of it is about just that.


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