What Matt Hancock’s arrival means for the NHS

Talk to anyone who knows the new health and social care secretary Matt Hancock well and the phrase “doesn’t lack confidence” is likely to feature.

Indeed, it is hard to imagine Jeremy Hunt, hardly a shy man, displaying this level of bravado.

Mr Hancock has been a highly driven and intelligent adviser, MP and minister with a well-honed and robust modus operandi. One seasoned observer of Conservative politicians remarked that Mr Hancock reminded them of former deputy prime minister Michael Heseltine, who was fond of telling party colleagues: “You don’t have to like me, just watch me win.”

While “a shooting star leaping through the sky” might be pushing it, Mr Hancock’s career to date (he is only 39) shows he is keen to make his mark as rapidly as possible, wherever he goes.

Within days of taking up his new post he used HSJ to declare his “love” of and undying belief in the NHS and pledged to “defend and champion undervalued” NHS staff. The desire to speedily reset the difficult relationship that Jeremy Hunt had with the NHS workforce is palpable. 

That said, we should be careful of jumping to assumptions. He accepted a demotion to remain in the May government and, therefore, survived the purge of his fellow Osbornites. This shows he clearly also has a streak of pragmatism – a vital ingredient for survival as a health and social care secretary.

Mr Hancock is plainly bright enough to realise that his new job is a big step up and that the NHS has a way of fiercely schooling unwary and cocksure newcomers to the brief.

Mr Hunt was in post for such a long time that it is possible to forget how much of a difference a new health and social care secretary makes. This changing of the guard is particularly important because it is the first since a fundamental power shift in the NHS.

Mr Hunt found his niche fairly quickly, and established a cordial and increasingly effective working relationship with Simon Stevens. Will Mr Hancock be prepared to see himself appear in second place in the HSJ100 list, a position well established for Mr Hunt in recent years?

There are plenty in senior Conservative circles who feel the NHS England chief has got too big for his boots and will be urging the new health and social care secretary to clip his wings. Hopefully, Mr Hancock will instead listen to the counsel of the new foreign secretary.

How much involvement Mr Hancock tries to take in the development of the promised “10 year plan” will provide the acid test.

Another early indication of how the new health and social care secretary conceives his role will be whether he continues to call and chair the controversial Monday meetings of the service’s senior leadership. Mr Hunt declared that “I am quite confident that the civil service would brief any successor of mine that it is essential to have those Monday meetings”. Well, we shall soon see whether that advice is forthcoming and if Mr Hancock heeds it.

Like any cabinet minister new to a department, Mr Hancock will be drowning in advice and his most pressing job will be to separate the valuable from the special, pleading, identifying the issues which need urgent action.

Unsurprisingly, the most immediate matters have pound signs attached to them.

Mr Hunt did not “do money” well until the very end of his tenure. Mr Hancock has a masters degree in economics from Cambridge and is a former Bank of England economist; he is likely to want to get stuck in.

His first test will be what to do about winter pressures funding. A decision is due before the end of the month. Mr Hunt was considering capital bids (to be funded by already allocated cash) for projects like building ambulatory care facilities. A decision is required in short order if winter funds are to do anything other than repair balance sheets. There is also the possibility of OK-ing more revenue funding, as any new facilities will need staff.

Past health secretaries have often rebuffed pleas for extra funding just to later crack when performance deteriorates, by which point it is too late for the cash to have much impact. Will Mr Hancock take a different tack?

His mind will have already turned to the five year funding deal announced by the prime minister in June.

It would be understandable, given the austerity elsewhere in government, if he felt he was about to enter a land of riches. It is vital for both him and the service that he quickly realises how tight the settlement is and that subsequent budget jiggery-pokery, with education funding for example, could yet render it inadequate.

He will also have to learn to control any (again understandable) frustration that he has little discretion over how apparently huge budget increases are actually spent.

Perhaps the most interesting implication of someone with Mr Hancock’s background arriving at the Department of Health and Social Care will be how he views the provider sector deficit. It is not hard to imagine him wanting to strongly influence the debate over control totals, the sustainability funding, the struggle to deliver recurrent efficiencies, constrained use of capital and the shift from tariff based payment systems.

Of course, there is a bewildering range of equally demanding issues for the new health and social care secretary to consider in the medium term: social care reform, a workable plan for winter, new contracts for GPs and consultants, living up to promises on mental health care, the digitisation of the NHS, reviving public health, and the possibility of guiding a new NHS legal framework through Parliament.

With British politics so febrile, it is hard to predict whether this government will last four months or four years, so for Mr Hancock getting to grips with the tasks ahead will feel more urgent than ever. HSJ wishes him good luck.