The final days of the Conservative campaign have been disrupted by an event that a combination of years of relatively low increases in funding and a winter campaign always risked: a photograph of a four-year old boy, Jack Williment-Barr, sleeping on a pile of coats on a ward floor because of a lack of beds.
Matt Hancock has been despatched to the hospital — not because he’s the Secretary of State for Health you understand, but because he’s one of the Conservative Party’s most reliable media performers. His brief will be to generate a better clip for the six and ten o’clock news than the pictures of Boris Johnson pocketing the phone of Joe Pike, the ITV reporter who tried to show him a photo of Williment-Barr.
The policy reality is that Hancock has no more power to “fix” the immediate problem than you or I. Thanks to the passage of the Health and Social Care Act — the controversial reforms introduced by Andrew Lansley that nearly upended the coalition government in 2012 — the secretary of state for health no longer runs the NHS in England in the way that we still expect. They set strategic priorities, but the operational running of the English NHS is in the hands of an appointed official: Simon Stevens, NHS England’s chief executive.
This is one reason why the two politicians to hold the job of secretary of state since then have spent a great deal of their time on side projects: in the case of Jeremy Hunt, on patient safety, and in the case of Hancock, on the NHS’ digital operations. They have effectively become lobbyists for more money for the health service, not its de facto chief executive.
Does this new model work? Well, we can’t really assess its effectiveness because for the entirety of the seven years since the act passed into law, the NHS has had below-average increases in its funding in real terms and the rest of the public realm has experienced real-terms cuts, which increase the pressures on the NHS. (Not least the biggest problem in terms of available beds, which is that in cutting other services, it is harder and harder for hospitals to discharge patients, particularly elderly patients or those with other acute care needs.)
I still think it is likely that the Act will be substantially repealed or amended sooner rather than later, because we at present have a situation where the secretary of state for health takes the blame but has no ability to immediately bring about change. Even funding increases — one other consequence of the act is that the secretary of state has in reality become the service’s chief lobbyist for more money from the Treasury — can be secured by the politician in charge but their use is set by the chief executive.
If it endures, we need a far greater level of media and public awareness about what the act means. We would never allow a modern chancellor to act as if they could still control interest rates — we shouldn’t allow a Secretary of State for Health to pose as if they can descend on a hospital and, at a stroke, take control of the situation.