Hancock, redux

The health and social care secretary was widely expected to leave for a new job in Boris Johnson’s first cabinet reshuffle. But he’s back. Lyn Whitfield considers his first year in office, his possible new priorities, and where the latest round of politics leaves NHSX and the health tech agenda.

Boris Johnson was elected leader of the Conservative Party on Tuesday and became prime minister on Wednesday. One of his first actions was to sack and then appoint a new cabinet; in which health and social care secretary Matt Hancock was one of the few survivors to stay in his old job.  

So, a year and two weeks after he took up the post, he finds himself back at the Department of Health and Social Care, facing more or less the same challenges as he faced last July.

Number 10 sets new priorities

One reason for this is that, until now, Hancock has been following an agenda that was set by his predecessor, Jeremy Hunt. Working with NHS England chief executive Simon Stevens, Hunt secured a £20.5 billion a year “birthday present” for the NHS to mark NHS70, to kick-in by 2023-24.

Stevens then launched an NHS Long Term Plan to set out how the money would be spent on cancer, mental health, primary and child health services, and on pushing ahead with the Five Year Forward View’s agenda of population-level planning and integrated care delivery.

Think tanks have been warning there is “unfinished business” on health funding and urging the Treasury to address capital, public health and social care in the upcoming comprehensive spending review – assuming that this takes place this autumn.

But the long-term plan has moved forward. NHS England and NHS Improvement have all-but merged and are setting up a new regional structure. A long-term plan implementation framework has been issued that local areas must use to inform their own strategies by November.

A whole new organisation type, the primary care network, has come into being. More publicly, patient satisfaction and performance against key targets has continued to slip.

Hancock has had little input into or comment on any of this. Which made it interesting that, in his first speech as prime minister, Johnson chose to say: “it will be my job to make sure you can see a GP in less than three weeks” and that he would invest in “20 new hospital upgrades.”

Some political commentators have speculated that Johnson is anxious to be seen to be delivering on the promise made on the now-infamous Brexit Bus to spend £350 million a week on the NHS. But a Number 10 hospital building policy might bring the government into some conflict with an NHS England committed to integrated care, delivered closer to home.

The social care crisis: even more intractable than Brexit?

Johnson also promised, in his first speech, to sort out social care, claiming that he has “a plan to fix the crisis once and for all.”  Which was well received by health and local government commentators, who have been warning for years that the situation is urgent, while seeing deadlines for a new green paper come and go.

Niall Dickson, the chief executive of the NHS Confederation, said tackling social care was “urgent” while the Local Government Association urged him to make funding it “an immediate domestic priority.” Hancock may now have to deliver that much-delayed green paper. But, even if he does, there is no way that the NHS or social care are going to be more immediate priorities than Brexit.

The NHS Brexit Alliance has been warning for two years that a hard or no-deal Brexit will have a significant impact on the operation of services in areas that could be gridlocked by customs queues, such as Kent, on staffing, research, regulation, and access to medicines and treatments.

In his list of “priorities for the new prime minister”, Dickson said that if it was impossible to secure an EU exit deal, the government must make sure that “patients will not be put at risk and that there is a transition period to make sure they are protected.” Perhaps thinking of Johnson’s assurance that he would deliver Brexit by 31 October “do or die”, he added that “nothing less is acceptable.”

Marking the scorecard

Hancock’s own stated priorities, when he took office, were: staffing, prevention, and technology. Taking him at his word, public health has been his biggest failure to date. Longevity has stalled or is falling, and public health experts calling for an inquiry into this unprecedented situation have pointed to austerity and growing inequality as the causes.

Hancock came in for considerable criticism in the final days of the leadership campaign for attempting to pull a consultation on prevention that suggested expanding some of the ‘sin taxes’ that Johnson had come out against.

But public health experts argued that if even if had been launched with the normal press release and ministerial statement, it would have been a disappointment. David Buck, a senior fellow at the King’s Fund, described it as “falling short of the scale and ambition needed to address the big health challenges we faced as a society.”

Meanwhile, following last year’s injection of cash, the NHS Confederation’s annual survey this year discovered that staffing has become the number one concern of NHS managers, given that the health service now has 100,000 vacancies.

As long-term health correspondent Denis Campbell pointed out in the Guardian, when Hancock was widely expected to be leaving for the Treasury, the minister’s time in office has seen virtually no progress on this issue. There is an ‘interim’ NHS People Plan; which Campbell described “to use a phrase beloved of his new boss” as “a pile of piffle.”

Hancock’s tech legacy

Which leaves technology. This is the one area in which Hancock made a significant splash in his first year. One of his first actions as health and social care secretary was to publish a blog post criticising the state of the IT that he had seen during a night shift with a London trust and the London ambulance service.

He followed up with a tech vision that put a strong focus on cloud-first, internet-first services and interoperability between NHS systems driven by standards. And then he announced the creation of NHSX, a new unit to bring together policy and standards setting – and to overhaul just about every other aspect of health tech, from security to procurement.

NHSX officially started work at the start of July, with a chief executive, Matthew Gould, appointed from Hancock’s former department of Digital, Culture, Media and Sport, and a chief technology officer, Hadley Beeman, recruited from his own pool of advisors.

When it looked as if Hancock might be leaving for another department, members of the Highland Marketing advisory board expressed the hope that NHSX would be his legacy at health. Andy Kinnear, who described Hancock as “the most pro-digital secretary of state in my 29-year career” argued that while it is still too early to say whether NHSX will be successful, “all the signs are positive.”

“The reduced fragmentation of decision making, the focus on standards and the internet-first approach, not to mention the appointment of what Joe McDonald, the outgoing chair of the CCIO Network, has described as a ‘weapons grade civil servant to lead it, all point to change – a welcome change – of direction.”

NHSX retains its sponsor; good news for its agenda 

Ravi Kumar said: “Since it is early days for NHSX, one would hope that whoever takes over at the DHSC would allow it to take shape and to deliver on digital technology.” From this perspective at least, Hancock’s return is a good thing: he has his own team in place at NHSX and is unlikely to alter its focus.

However, the new unit will still need to get itself embedded into the NHS’ new structures and come up with a solid plan to not just deliver on Hancock’s agenda but deal with the National Programme legacy of installed systems and Hunt’s contribution in the form of the global digital exemplar and local health and care record exemplar programmes.

The advisory board has suggested that it would do well to baseline digital maturity at trusts and health economies, to give it a measure to work from. Whatever it does, NHSX will need to move quickly. Because there are plenty of signs that Johnson’s administration could be distracted by Brexit and short-lived.

An early election or even a second referendum possible stop-points. If Hancock leaves health in this kind of scenario, questions about NHSX’s future will be raised again.

A growing to-do list

Meanwhile, Hancock’s second stint at the DHSC may see him spending less time on tech. His top priorities are likely to be steering the NHS through Brexit, addressing Number 10’s investment pledges, and sorting out social care (possibly). If he is in post for any length of time, he will also need to decide what to do about the long-term plan and (possibly) lobby the Treasury for support on capital, staffing and prevention.

As Campbell pointed out, he has a lot of ground to make up in these areas, and some bridges to build with NHS policy makers and managers, given his abrupt decision to abandon his department for a leadership run that ended in support for Johnson.

But the NHS Providers organisation, at least, was grateful to see some continuity. “Matt Hancock’s re-appointment provides important continuity for the NHS at a key time,” said deputy chief executive Saffron Cordery. “He has been quick to acknowledge many of the challenges the service faces, including the priorities he set when he first took on the job – workforce, technology and prevention.

“As implementation of the NHS Long Term Plan gets underway, his experience of the NHS and encouragement of innovation will be a great strength for the service as it seeks to transform services to meet 21^st century needs.”