Sajid Javid’s appointment as health secretary replacing Matt Hancock at the Department of Health and Social care comes at a time when, as the British Medical Association put it, he has “probably the most daunting in-tray that any secretary of state for health has ever inherited”. Covid, the NHS’s unique role in British life and the pressures it is under mean that Javid is now the most high-profile job in the government after the prime minister. Whoever holds the post regularly has to take big, often controversial, decisions. The next few weeks will test his skills and also his judgment on the next steps in the vaccine rollout, NHS pay and the identity of the health service’s new boss, while the rest of the year will involve big calls on NHS funding and social care.
Covid vaccination The huge effort to get Covid vaccines into people’s arms is going well. So far 44.3m first doses and 32.5m second doses have been given across the UK. The NHS in England expected to have vaccinated half of those under 30 by Sunday night. Several studies have shown that the main vaccines used so far have limited the spread of the disease and reduced the risk of people becoming seriously ill, which has helped keep the pressure off the NHS – so far. However, infections are rising significantly again, prompting many scientists to warn that there is no room for complacency, especially if the delayed further easing of restrictions on social contact in England does go ahead on 19 July. Javid will have a key role in decisions over the next few weeks about whether, when and how to extend vaccination to under-18s and also how to deliver booster jabs to adults in the autumn. He will also have to get up to speed quickly about the pros and cons of pressing ahead with “freedom day” on 19 July. It is unknown if Javid will follow Hancock’s generally cautious approach or press ahead with moves such as scrapping the “rule of six”. Waiting times for NHS care There are now 5.1 million people in England waiting for hospital treatment – the most ever. Waiting times were getting worse even before the Covid pandemic struck in February 2020, but they have deteriorated sharply since. Overall 93% of those waiting should be treated within 18 weeks. But more than 383,000 have already waited more than a year and 2,700 more than two years – delays that were highly unusual until recently. NHS hospitals are trying hard to reduce the backlog but their capacity to make inroads is limited by staff shortages, illness and those taking a rest.
Waiting times have the capacity to mushroom into a major political headache for the government. In recent months Downing Street has appointed several big hitters in No 10 specifically to focus on tackling delays. Javid may come under pressure to intervene and try to drive faster progress. But hospital bosses, senior doctors and health policy experts say there are no easy ways to cut waiting lists and shorten waiting times, given historic underinvestment. NHS pay The government provoked fury in March when it proposed to give the bulk of NHS staff a 1% payrise, despite their huge extra efforts to care for Covid patients over the last 16 months. Health unions have described the offer as “insulting” and the Royal College of Nursing (RCN) has threatened a strike. Matt Hancock, while still health secretary, said that an increase higher than 1% was not affordable. The RCN has asked for 12.5% and begun preparing for a strike ballot of its 450,000-strong membership. If the government refuses to increase its 1% offer Javid will have difficulty earning NHS staff’s respect and may get off on the wrong foot with workforce leaders whose trust he needs. The Treasury fears that a higher settlement could prompt demands from elsewhere in the public sector for equivalent rises. But public opinion seems to strongly support staff getting more than 1%. NHS reform The government will soon publish its health and care bill, which will instigate the biggest changes to the NHS in England since Andrew Lansley’s hugely controversial shake-up in 2012. There is broad support for many of the legislation’s aims, such as speeding the integration of health and social care. But Javid will face parliamentary battles over other elements, including handing the health secretary much greater “powers of direction” over the running of the NHS in England and also its failure to include a plan to end the understaffing of the service. With the legislative process likely to drag on for many months, Javid may find the timing of its arrival unhelpful as he seeks to deal with the many other pressing issues in his in-tray. Who succeeds Sir Simon Stevens? Sir Simon Stevens is standing down as the chief executive of NHS England at the end of July after seven years in the job. He has won widespread praise for standing up for the NHS, especially its need for budget rises. Javid will have a hand, alongside NHS England’s board, in choosing his successor. The government is thought to want a much lower-profile, less independently minded and less political successor to Stevens, especially with the increased powers the health secretary will acquire through the bill. Amanda Pritchard, Stevens’s deputy, and Sir James Mackey, the chief executive of the Northumbria healthcare trust, have applied. But so has Dido Harding, the Tory peer who runs the government’s much-criticised £37bn test-and-trace programme. Social care Boris Johnson promised the day he became prime minister in July 2019 to fix social care with a plan which he said was ready to go. Since then, his government has done nothing to end the scandal of growing numbers of older people missing out on the help they need to keep living independently at home and with dignity. Johnson called off a meeting due last Tuesday to plot the way ahead. Detailed plans are promised “by the end of 2021”. Javid will be familiar with the political and financial complexity of reforming social care from his time as chancellor of the exchequer. Since then, the human need involved has grown, and as the secretary of state for social care he will be expected to lobby for urgent reform. But he may not find it easy to prise the necessary cash out of his old department, which is faced with the £350bn cost of tackling Covid.