Analysis

A formidable in-tray – from Covid response, to driving cross-NHS cultural change

Paul Burstow and Jaber Mohamed

As Sajid Javid, starts his new job as Secretary of State for Health and Social Care he faces a formidable in-tray.

The pandemic is far from over, unlocking the lockdown is proving a game of snakes and ladders. Javid has already been warned that his first priority needs to be the continued success of the vaccination programme if we are ever to see our lives return to normal.

Ensuring the NHS has the resilience necessary to face any future waves of new Covid variants is also pressing. Tackling burgeoning waiting lists will be a very visible litmus test for Javid. More than 5.1 million patients in England are waiting for treatment, the highest since modern records began, and the number is likely to keep on going up as Covid admissions continue to disrupt the recovery of other services like cancer care and routine surgery.

The list of operational challenges is growing. The coming winter could be as challenging as the last though in different ways.

Flu was effectively suppressed last winter thanks to social distancing. That means less residual population immunity and medical experts have warned that the coming winter could see a nasty resurgence of flu.

The last bad flu season was in 2018 and then – even before Covid existed – there were widespread suspensions of routine operations and procedures.

The rollout of booster Covid jabs in the autumn and linking that to the flu campaign could be even more complex than what’s been run up until now.

These challenges are compounded because NHS and social care staff and leaders are exhausted from dealing with the pandemic. But there is no quick relief in sight with multi-year training required for new doctors and nurses. There is also a very tricky decision to make on pay soon following an outcry after an earlier 1% pay offer to many health workers.

And the list of strategic challenges is daunting.

The reform of social care has been left in the ‘too difficult to do’ drawer by successive Governments. Yet landing the integration agenda requires a Long Term Plan for social care. Javid’s Treasury experience could stand him in good stead when he sits down with the PM and Chancellor to agree a plan.

Within days Javid will have to kick off the Parliamentary scrutiny of the Health Bill. Any delay will spell trouble for an ambitious timetable that sees Integrated Care Systems (ICS) formally established from 1st April 2022.

Unlike the 2012 reforms the move to integrated, place based care and population health has NHS backing. But Javid will have to decide whether he sticks with Hancock’s plans to take new powers to direct NHS England. There were already rumblings on the Conservative backbenches about the plan, is this a fight Javid wants to have?

And with Sir Simon due to step down as NHS England CEO this summer Javid and his boss the PM will have to decide what sort of ‘guiding mind’ they want at the top of the NHS. How long will the leash be?

All this while the UK Health Security Agency is being set up and absorbing some of the work of key agencies involved in the pandemic response, such as NHS Test and Trace and Public Health England.

Steering the Health Bill through Parliament won’t be without its challenges, especially in the Lords. But it will be its implementation and impact that the public will judge.

The centre always has to resist a strong temptation to micro-manage the NHS, both from the Department and from NHS England. But the ICS project is predicated on a very different model of place-based collaboration and system leadership to deliver more person-centred care, make a reality of prevention and tackle inequalities of access and outcome.

Without the culture change the new structures will fall short of the ambition looking up for direction rather than out to the communities they serve. Appointing an NHS CEO who can foster that culture, manage political expectations and let the ICS reforms mature and deliver may be the most important NHS legacy of Javid’s tenure.