The Primer: The best laid plans

With Sajid Javid notching up 100 days as health and social care secretary last week, there’s been plentiful media coverage about what he will do next with his new train set. Some of it has been based on his own direct comments, some is more speculative. 

Starting with the latter, the Observer yesterday reported that Mr Javid is considering a radical melding together of health and social care together, as part of government’s promised integration white paper. Care policy veteran Richard Humphries points out on Twitter how this story has reared its head quite a few times over recent years. If we had a pound for every report of a government exploring “total integration” of the two, we’d have enough for a substantial section 75 pooled budget overseen by some complex joint governance arrangements. It is well worth watching this policy, though. Our Integrator briefing warned on Thursday that everyone involved in the white paper should “be very wary of enabling the government to again get into double counting of ‘pooled’ cash across the two ‘financially leaky buckets’ [of health and social care funding] which unfortunately still have large holes in”.

Probably more imminent than a generational reform of care provision is a Javid intervention on GP access and support. He resisted sticking the boot in over lack of face to face appointments at his party’s conference in Manchester last week, and is carefully walking the tightrope to try to keep the profession on side while doing enough for the Mail and Telegraph, and some of the public, who are hungry for in-person appointments. The Mail on Sunday reported: “Javid demands GPs hold more face-to-face appointments but plans to cut doctors’ workloads by removing some prescription responsibilities.”

Sacking managers

But perhaps the most eye-catching story for HSJ readers was the Times’ report on threats to sack NHS managers for poor waiting list performance. That came off the back of an announcement of a new review of health and care leadership. This tough talk worried some NHS leaders, as it did the Guardian’s Polly Toynbee.

Coming onto the news Mr Javid issued directly, the new-ish health and social care secretary presented a more nuanced picture of his place in his comments at the Conservatives’ autumn conference itself. He indicated he was concerned about variation in delivery, but said he would listen to the Messenger review rather than pre-judging. He did stress that 2022 would be a “year of reform”, however. The Saj also gave a softer message in a sit-down interview with the Guardian, advising people in need of operations to stick with the NHS rather than go private. He said he would focus on tackling health inequalities, something he spoke a lot about at conference fringe events, citing his background as the son of a Pakistani bus driver as putting him in a good position to push on this issue.

The promise of a bit of military discipline was effectively a piece of red meat thrown by Mr Javid to his party, much of which is concerned about the National Insurance increase kicking in soon and being poured into health and care. John Redwood, the staunch right-wing former cabinet minister, detailed his concerns on his blog, along with some sharp advice on how the review should be done. There were other nods to the right where that came from: a suggestion people should look to family before state for help, and that SAGE could be ignored if it asks for more lockdowns.

Javid’s priorities

That all sounds like a lot of plans. But the best laid plans often go awry, and the realities of pressure on the health and care system are also looming large this week.

When Mr Javid identified his top priorities, workforce, surely the most glaring of the health service’s current underlying problems, was notably absent.

This week the Observer highlighted nursing vacancy rates of 10-20 per cent at some trusts recorded in internal staffing reports, including claims that Brexit had contributed. Unfortunately, we suspect, these numbers are not worst of the shortages out there.

Jeremy Hunt, a regular contributor to the workforce debate now he’s Commons health and social care committee chair,  also chipped in this week - though not at his party’s conference. At the Society for Acute Medicine he repeated his view  - first manifested while he was in the Victoria Street hot seat - that the UK should not rely on overseas doctors as a “get out of jail card” for failing to train enough domestically, because the “tap is running dry”. His comments resonate with some more colourful ones from new minister Gillian Keegan about the “stupid” international nursing market at the party conference in Manchester. 

Mr Hunt also cautioned against Mr Javid’s leadership review leading to a targets and terror approach, which he said risked a repeat of Mid Staffs era neglect of safety. There was more on this theme in Mr Hunt’s excellent weekly email newsletter, where he also says “running a hospital remains the most difficult job in Britain today”. That might be enough to persuade senior readers from acute sector - so long as they are not still sore from Mr Hunt’s time at the top - to sign up. 

In another flash of the winter reality ahead, Jenny Harries, who leads the UK Health Security Agency, was on Sunday morning TV to warn of the twin risks of flu and covid - a concern already front of mind for many in the health service.

Her comments come as government published its plan for the winter flu and main covid booster campaigns, aiming for high uptake. The Financial Times has some analysis on why continuing to push vaccination of older people remains crucial to resilience across Northern Europe. 

Yet the Times asks why uptake of the covid vaccine been so slow among eligible under 16s in the UK. NHS resources are among the reasons cited.

And there are ongoing concerns about the difficulties that the first groups supposedly eligible for the booster have been having to secure them. The Mail on Sunday has the latest report.