A new health secretary, an overflowing in-tray

So, here we are. A new Prime Minister and a new Secretary of State for Health and Social Care. Shortly after Andy Burnham was handed the keys to No 10, he appointed his cabinet, with Yvette Cooper gifted the health and care portfolio. 

Cooper’s seniority and long political career send a clear signal about the type of health and care agenda Burnham wants to pursue, with social care expected to be given much more prominence and political backing. Burnham himself is a former health secretary so is very familiar with the pressures and complexities of the brief. Few roles in cabinet combine such public salience and political exposure, with the NHS consistently named in polling as one of the biggest issues facing the country and adult social care reform remaining one of the biggest unresolved policy questions of our time. 

Cooper is a political heavyweight, having served in various cabinet positions, most recently as Foreign Secretary and Home Secretary, and as an MP since 1997. Her first role in government was as health minister, when she helped implement the Sure Start programme. She is firmly in the centre of the Labour Party and while we shouldn’t overly rely on what people said a decade or more ago, Cooper has previously been reported as saying she wants to allow local government to control the NHS, which is 'precious' but 'struggling'.

Cooper inherits a department in the throes of major reform with the far-reaching Health Bill going through parliament, which is set to abolish NHS England, while integrated care boards (ICBs) are undergoing major disruption as they are required to halve their running costs. She also inherits a sweep of 10-year plans and strategies already set in motion – the health plan, life sciences sector plan, capital plan, cancer plan, upcoming workforce plan, and the Casey Commission on adult social care. So, while the new health secretary may want a reset, the agenda is already heavily set. 

Where then, to begin? 

The Health Bill will land near the top of the health secretary’s in-tray. With major implications for the structure and direction of the health service, the bill has attracted attention both inside and outside parliament. Proposals to abolish arm’s length bodies and centralise more power into the hands of the secretary of state are at odds with the government’s stated ambition to give patients more control over their health. They also sit uneasily with Burnham’s broader devolution agenda. Negotiating tensions such as these is a difficult task and may well require compromise. 

Other high-profile provisions include the creation of a single patient record, changes to the duties and role of ICBs, and the dissolution of Healthwatch. It has been speculated that the latter may even be dropped, with Burnham said to be concerned by the loss of independent patient voice. How far Cooper is prepared to go in pushing the Health Bill – as architected by Streeting and Starmer – through parliament without amendments or concessions to MPs and peers will be a telling first test. 

Social care reform – a can no longer kicked down the road? 

Many a health secretary has come into post vowing to ‘fix’ social care. Few end up doing so. Yet it is rare to have an incoming prime minister with such a clear promise on reform. Burnham has been adamant he would not ‘flinch’ from facing up to the difficult decisions in public funding and has long advocated for a more universal system of social care.

The Casey Commission is facing growing calls to deliver its verdict and recommendations before its 2028 timetable, with Burnham himself stating he would like it published by the end of the year. Whether or not the full timetable is brought forward, there is a strong case for interim action now: stabilising providers, meaningfully improving the pay and conditions of care workers, supporting unpaid carers and improving the interface between health and social care. 

There is an opportunity to use Baroness Casey’s national conversation with the public as a route to build a credible offer to the electorate within this parliament. That will not be easy. Social care reform costs money and political capital. It forces politicians and the public to confront questions about how much individuals and families should be expected to contribute to the cost of their care. But the cost of delay is greater, resulting in more people and their loved ones suffering the consequences. 

Delivery, delivery, delivery 

Under Keir Starmer’s administration, the 10 Year Health Plan was built around three shifts: from hospital to community, analogue to digital and treatment to prevention. Those shifts remain broadly the right ones. They reflect a long-standing diagnosis shared by many across the sector that the system is too hospital-centred, too slow to adopt technology and too reactive. Yet many of the big questions remain unanswered. What size and mix of workforce will the health service have in the future? How will money, staff and activity move out of hospitals and into the community? How will all this be delivered alongside commitments to drastically improve day-to-day performance? 

A criticism of Streeting’s leadership has been that the department spent the first year chasing announcements, pilots and headline-friendly targets rather than getting on with the job. There will likely be a temptation for the new secretary of state to rebrand and refocus the department’s strategy. Sinking too much time into this would be ill-advised, leaving the service in limbo and consuming attention away yet again from the task of implementation. Instead, a priority for Cooper ought to be publication of the delayed 10 Year Workforce Plan to give clarity and a long-term view for health service leaders. There is also an opportunity to give new life to commitments that have been pushed down the agenda, the new healthy food standard being one such example. 

Clearly trade-offs will need to be made across government and within health and care. Between delivering the new hospital programme and other investment under the 10 Year Capital Plan while finding extra money for the Defence Investment Plan. Between rolling out new neighbourhood health centres while restoring waiting times back to constitutional targets and improving public satisfaction with the NHS. Between speeding up adoption of the Federated Data Platform (while responding to concerns from the Health and Social Care Committee about the product) and digital transformation while footing the bill of new medicine pricing agreed under the UK–USA pharmaceuticals deal. It is unlikely that all will be achievable at once. 

Choosing ‘slow’ wins 

Some policies survive a change in political leadership, while others quietly lose momentum. Under Streeting – and James Murray for the short tenure he held – it was perceived that the digital shift held the most sway. However, Burnham is expected to demand a gear shift to bring the prevention agenda to the fore, looking beyond the NHS to the wider determinants of health and tackling health inequalities. 

This is key as the benefits to the population’s health from the shift to prevention are not realised in the short term. Delivering this shift requires spending political capital today for benefits that may arrive after the next election. That is why leadership and buy-in from Number 10 (and Number 11) are so vital. 

The biggest slow win of them all would be the revival of the health mission. The idea of mission-led government was to coalesce the machinery of Whitehall around ambitious and overarching goals. It was billed as a way of working as well as the end destination. Much has been said about the health mission since being missing in action, with the drumbeat of elective recovery and waiting times heralded in as the key milestones for the health of the nation. 

Burnham’s arrival in Number 10 could change that. His record of governing in Greater Manchester has been rooted in ideas of devolution and inequalities. His approach could mean going further and faster on devolving health-related powers, strengthening the role of local leaders and using public services more deliberately to tackle the wider determinants of health.

A revitalised health mission will only succeed if it has real teeth. That means accountability within the Department of Health and Social Care but also the Treasury and across government. If the mission is to improve health and reduce inequalities, then spending decisions should be judged against that test. Does this policy help people live healthier lives? Does it narrow or widen inequalities? Does it strengthen care in communities? Does it build long-term resilience, or simply move pressure around the system? 

An opportunity to course correct 

So, clearly the in-tray is full. Not everything can be a priority. Difficult decisions will have to be made and Cooper will also undoubtedly want to put her own stamp on the health and care agenda. 

Yet the moment does present opportunity. A new prime minister with a commitment to population health and inequalities. A new health secretary with a high public profile and authority as a longstanding senior government figure. A long-term strategy for the NHS that has broad consensus among those working in the health service. And, unusually, a government that says it is willing to expend political capital on social care reform.

So yes, risks and opportunities – and perhaps even hope.