Government is sharpening its scrutiny of the NHS

With Matt Hancock returned as health and social care secretary following last week’s reshuffle there will be a sense amongst HSJ readers that ’nothing has changed’. But changes are afoot in what he and the government will focus on, and how they will oversee the NHS to deliver it.

Performance

On being returned to post Mr Hancock recorded his latest video setting out both his exuberance at this outcome and priorities for action. Many of these were a repeat of his first speech following the December election at Policy Exchange where he spoke of people, technology, prevention and infrastructure.

Following the worst performance statistics on record, a sudden interest in waiting times is of course not surprising 

But it was the mention of “performance” in the 31 second clip on Thursday which was notable —  the word did not feature in his December speech at all. Indeed Mr Hancock has rarely spoken about performance at all, as John Appleby from the Nuffield Trust observed last week, asking: “Who takes responsibility for this ongoing decline in the quality of NHS services to patients and the public?”

Following the worst performance statistics on record, a sudden interest in waiting times is of course not surprising. But there is also a growing sense that the public now wants action. 

Polling from JL Partners showed reducing waits for accident and emergency, GP appointments and for planned operations were three of the top four priorities for voters on health following the election (just behind increased staff numbers).

Number 10 has trebled the number of focus groups it carries out (and even apparently live streaming them into the building), the prime minister spoke of cutting waiting lists at Friday’s cabinet meeting, and there are now regular stock-take meetings between 10 Downing Street, the Department of Health and Social Care, and NHS England. So it seems performance is now once again the main issue occupying minds at the centre of government.

Accountability

The slide in the performance numbers, a larger than expected majority and the centrality of the NHS to the election victory has led to the exploration of what new powers ministers could take in setting direction to NHSE; as reported recently by The Times.

The current model of NHS independence clearly does not suit the Number 10 world view of directional oversight of key organisations to drive improvement.

Critics will argue that any moves will miss the point. They argue that direct ministerial control is not a solution to performance issues which are driven by a multitude of factors, many beyond the boundaries of the NHS. And as Dave West adeptly argues legislative change will not likely come in until April 2022 making it a medium-term lever for change at best.

However, and as I wrote in HSJ in December, greater oversight, scrutiny and accountability will be here to stay as “the people’s government” gets to work.

Tensions between government and the NHS on implementing the Conservative manifesto commitments on health — particularly on performance; how they align with the implementation of the NHS long-term plan; and how they are paid for is highly likely in the weeks ahead. And there is also the thorny issue of whether to change the waiting times targets for A&E coming ever closer.

Funding

If the NHS wanted a case study of what can happen when Number 10 gets frustrated, then it need look no further than developments at the Treasury. The decision to move to a joint Number 10/11 advisor unit and Sajid Javid’s departure has sent shockwaves through both Whitehall and the Conservative party.

Number 10’s takeover last week leads to more questions than answers on health, but the change could be seen as supportive of further investment at the upcoming Budget in March and spending review later in the year.

With number 10 seemingly in greater ascendancy, unlocking new money for voter priorities may be a little easier and could even help reduce tensions between number 10 and NHS leaders

The existing long-term plan funding settlement (and the influx of more new cash for the NHS under Johnson last summer) would have seen the Treasury digging in and playing hardball on other areas of health and care spending – particularly on expensive items like social care and capital.

With Number 10 putting its foot down, unlocking new money for voter priorities will be a little easier, and could even help reduce tensions between Number 10 and NHS leaders.

Thus while the headline news from the reshuffle in health and social care was continuity, to say ’nothing has changed’ would be wide of the mark.