What’s in Sajid Javid’s in-tray? A health and social care to-do list

It’s difficult to think of a tougher time to transition to a new Secretary of State for Health and Social Care. The Civil Service machine will have been whirring into action – briefing the new Minister, working out which decisions can wait and which can’t, who to meet.

I’ve worked in a Minister’s office when there was a reshuffle and in a Secretary of State’s office so I have a good sense of what those (virtual) corridors will be feeling like at the moment. What is in Sajid Javid’s in-tray?

The immediate questions will be about the Covid-19 pandemic, which will require decisions over the next few days and weeks. On the approach to relaxing restrictions next month, Javid has already made his view public, but there will also be choices about when and how to deliver a vaccination booster programme this autumn to help maintain protection from serious Covid-19 illness and prevent the NHS being overwhelmed. Alongside this will be thinking around how the NHS can prepare for what could be a bad flu season.

'He will play a role in choosing the next chief executive of NHS England, a decision that will be critical for the future of the service.'

The new Secretary of State also faces the need for some rapid decisions on fundamental questions of structural and system reform across the NHS, public health and social care. On the NHS, he will play a role in choosing the next chief executive of NHS England, a decision that will be critical for the future of the service, but another key decision will be what to do with the Health and Social Care Bill which legislates for the vision in the White Paper. This Bill was to be introduced within the next few days. Will Sajid Javid keep the more controversial elements of the Bill, instated by his predecessor, which give him more power over national bodies and local systems?

If the Secretary of State is considering a delay in publishing the Bill while he considers the issues, he needs to think hard but quickly. The NHS is already moving ahead with implementation and guidance from NHS England on some aspects of it. Pausing therefore risks even more disruption over a longer timeframe. Of course, there will be concerns – for example, about the proposed new powers for the Secretary of State over NHS England, reconfigurations and arm’s length bodies – and elements of the Bill that will need improving and refining. So, the best option may be for the Secretary of State to listen and make changes as part of the legislative process, rather than delay the Bill and start another round of engagement, with the disruption that would cause to the system.

Talking of organisational change, Javid has inherited a half-started set of changes to England’s public health infrastructure with the abolition of Public Health England, which needs to be completed. Finally, the question of social care reform – with the background of much-leaked discussions between the Prime Minister, Chancellor and former Secretary of State suggesting they are circling around final decisions on funding reform. Will Javid use his experience from the Ministry of Housing, Communities and Local Government, where he had responsibility for local government funding, to push for a broader, more ambitious set of changes that tackle quality, the workforce and unmet need as well as the narrow question of funding in the Manifesto commitment? His time as Business Secretary may also mean he can see the potential of social care reform through the lens of the economic value of the sector.

'With public finances looking extremely difficult, his HM Treasury-insider knowledge should help him make a successful case for investment for the NHS, social care and public health.'

The autumn should bring a Spending Review – a key moment to set the medium-term strategy and plan. With public finances looking extremely difficult, his HM Treasury-insider knowledge should help him make a successful case for investment for the NHS, social care and public health. From a policy perspective, there are three big questions here that need a multi-year approach to tackle. First, the workforce across the NHS, social care and public health. Before Covid-19, the health and care workforce was facing a crisis, with high levels of vacancies, turnover, and stress and the past 18 months has only made this worse, with an exhausted workforce. A comprehensive workforce plan will need to look at international recruitment, training and development of staff, and workplace culture and practices.

Second, looking across health and care, the backlog of care is being strongly felt by patients and by staff alike. Waiting times are ballooning, urgent and emergency services are under extreme pressure, patients are struggling to access primary care , and mental health services are seeing a massive increase in need. This is not a challenge that can be solved overnight but will take years to get right. It’s also a problem where Javid must always think system, not silo – the abundance of data about acute hospitals and the resulting visibility of problems in this sector make it tempting for this to be the main focus for a Secretary of State. That would be a mistake and a failure to understand how the connected different parts of the health and care system are.

Third, and underpinning all of these areas, all parts of the health and care system will need to have a much stronger focus on health inequalities. The past 18 months have shone a tragic light on the longstanding inequalities that exist in society, and have made it clear the health and care system has to make a step change in how it tackles inequalities in health. As we wrote earlier this month, tackling inequalities needs to move from a ‘nice to have’ to a ‘must have’ in the NHS, and the new Secretary of State should use the cross-government structures promised after the abolition of Public Health England to make sure health inequalities becomes a key focus right across government.