Sajid Javid may have already served in two of the most testing offices of state, as chancellor of the exchequer and home secretary. But on Saturday he walked into what is now arguably the biggest and most challenging of all: the job of health secretary. Not only does Javid have to steer the country out of what will hopefully be the final stages of the pandemic, ensuring we reach the end of what Boris Johnson has called the “irreversible road to freedom”. But assuming we reach that destination he must also take on what could be even harder tasks: those of catching up on the vast backlog of delayed operations, and remodelling the service so it is able to react to any future pandemic more effectively than it did this time round. Then there will be the giant challenge of social care, cruelly and terribly exposed as unfit not only for a pandemic, but also for the 21st century. Add to that the expected post-pandemic crisis in mental health, and his in-tray will be overflowing. In some senses Javid will find his new job easier than his last. His brief stint as chancellor ended after he lost a power struggle with Johnson over the role in government of Dominic Cummings. Now Cummings is gone and is not coming back. That irritant is out of the way. But in every battle Javid fights from now on there will be another familiar problem: money. How to fund a reshaped, modernised health service from Treasury coffers already run bare by the pandemic. How to modernise social care without blowing another hole in the public finances, or putting up taxes, or slashing pensions. The prospect of either will be hugely unpopular with the Tory party and its MPs. Hancock may have had his enemies, Cummings chief among them. Johnson may have thought Hancock made big mistakes by failing to protect care homes and their residents during the pandemic, but the former health secretary had been in his job since before anyone had even heard of Covid-19. He knew the pandemic backwards, all the failures, the disasters, the successes too. That was clear from his recent evidence to the health and science committees when answering Cummings’s charges that he was a blundering incompetent.
Javid has no such knowledge. He starts at Go on the pandemic Monopoly board and has to move through the streets fast. Then must come the planning for a future NHS. Hancock was due this week to put forward a bill on NHS reform that would have seen the service streamlined in the aftermath of the Lansley reforms, concentrating more power back in the hands of the secretary of state. Javid must see if he likes the plans, before he adopts them. Delay is likely. Whatever fledgling plans were in the pipeline for social care, Javid must revisit them too. Everything will go back to the drawing board. No wonder the health sector was anxious, while relieved that Hancock had gone, his authority having been finally shattered, after weeks of negative stories emanating mainly from Cummings. Dr Katherine Henderson, the president of the Royal College of Emergency Medicine, said she was “genuinely grateful” that Hancock had supported a review of how hospitals measure emergency department performance, to ensure that A&Es were not starved of resources. “I hope his successor will understand the linkages between elective and unscheduled care,” she said. “We cannot have one working successfully without the other.” Javid will walk into his new department with a daunting road ahead. All that will be empty will be the secretary of state’s chair. Vic Rayner, the chief executive of the National Care Forum, said: “The social care sector needs Sajid Javid to urgently take forward the agenda around reform. It is not possible for there to be any further delay on this. It is vital that his ambition for social care extends beyond a quick fix, and that he will secure a long-term future that is strong on ambition, and backed by an unambiguous investment agenda that ensures that social care that we all want and need is available to change lives now and in the future.” Shadow health secretary Jonathan Ashworth suggested he would face financial challenges partly of his own making: “In his brief stint as chancellor, Javid failed to reverse the Tory cuts that healthcare services had suffered,” he said. “With waiting lists sky high, cancer treatment delayed and young people struggling to access mental health care, his challenge will be to bring waiting lists down, recruit the staff the NHS needs and give them a pay rise – and fix social care which has repeatedly suffered deep and devastating cuts.”
Responding to the announcement of the new health secretary, Pat Cullen, acting general secretary and chief executive of the Royal College of Nursing, said: “Sajid Javid must hit the ground running. With the unrelenting pressure on the nursing workforce, their role in protecting the nation during the pandemic and role delivering the vaccination programme, we expect to meet with urgency. “Javid’s immediate priority must be tackling the shortage of nursing staff and paying them fairly for their highly skilled and safety-critical work.”