Public Affairs & Government Relations

FTI Consulting Public Affairs Snapshot – What will Sajid Javid mean for health and social care?

Following the resignation of Matt Hancock at the weekend, his successor – Sajid Javid – faces an almost unprecedented in-tray in his new Department. FTI Consulting’s Public Affairs team has provided in-depth analysis of what his key priorities will be and the politics behind the new Secretary of State for Health and Social Care.

Overview and the response to COVID-19

Sajid Javid used his first news broadcast to the BBC at the weekend to declare his “immediate priority” was to return to normal “as soon and as quickly as possible”. Indeed, it is highly likely that the new Secretary of State will adopt a different approach in the government’s response to COVID-19 to that of Matt Hancock, who was increasingly one of the most fervent ‘doves’ in the Cabinet to support stringent measures to combat the pandemic.

Indeed, during last summer’s respite in between lockdowns, Javid remarked that the government should “run the economy hot” and lift restrictions to encourage economic growth. His first test as the new Secretary of State will come this afternoon (28th June) in a statement to the Commons on the latest date on the Delta variant. Any hopes of an early release, mooted to be on 5th July, looks set to be quashed as the 7-day rolling average of infections are rising at more than fifty per cent. Despite that, the link to hospitalisations looks increasingly to be broken – as hospitalisations have risen by only ten per cent in that time. But even that modest rate of increase is causing significant problems to an NHS that has a backlog of five million operations, treatments and care.

NHS leaders are already warning the government that they fear what the winter may bring for the NHS, not only in terms of the seasonal influx of patients, but also a potential fourth peak on an already overstretched health service. Javid is likely to come under pressure from a significant caucus within the Conservative Party, some eighty-strong, which is increasingly restless at the measures in place to mitigate COVID-19. Javid was reluctant as Business Secretary in 2016 to intervene when British steel was threatened; given the levels of state intervention and spending emanating from Victoria Street, it will be worth closely watching Javid’s early instincts and any tensions between his past and current political orthodoxies.

Javid is also the first ethnic minority holder of the post and the first to be a former – albeit brief – Chancellor. There may never have been a Secretary of State for Health and Social Care who has as much Cabinet experience as Javid as a former Home, BEIS, DCMS and MHCLG Secretary of State. In the past eight years there has only been two Health Secretaries, but Javid has held eight Ministerial roles, including as two in the great offices of state. It is a testament to how he is viewed as the modern day John Reid, fire-fighting in tricky government departments, or a latter-day Kenneth Clarke. The truth is that Javid has never been in a post longer than two years and given all the Department of Health and Social Care has to juggle in not just the tail-end of the pandemic but for the years to come, Javid will need to demonstrate longevity in post as well.

On the Conservative backbenches, Javid is highly regarded as a competent Minister and an astute politician. His appointment, and, as noted, his stance on lockdowns, will be widely welcomed by his colleagues. His enduring Cabinet career is in part due to his advisers – all of whom are seasoned political operatives and deeply loyal to their principal. It is known that one Javid’s longest serving advisers, Sam Coates, has already been appointed as Special Adviser at the Department for Health having returned following his dismissal from Dominic Cummings in February 2019. Emma Dean, Hancock’s former Special Advisor but a former aide to Javid’s 2020 leadership campaign, has been retained.

Lastly, Javid’s appointment will alter the power dynamic and likely establish greater alignment between 10 Downing Street and the Department for Health. The Prime Minister’s wife, Carrie Johnson, is a former Special Adviser to the new Secretary of State and they have remained close personal friends ever since. The appointment of Mrs Johnson’s closest friend and the Prime Minister’s Senior Adviser, Henry Newman, has reportedly already seen an increasingly less fractious atmosphere in Downing Street and improved its relationship with key government departments.

The government’s Bill to reform the NHS in England

Javid is expected to visit a hospital today to thank NHS staff for their work during the pandemic and the vaccination roll out, but alongside grappling with a public health crisis the new Secretary of State will also have to steer Matt Hancock’s Health and Care White Paper through Parliament.

The proposals are the biggest since Andrew Lansley’s controversial 2012 Health and Social Care Act reforms, which the new White Paper is largely unpicking. It can expect a bumpy ride in the Lords, in particular, from the Labour Party, which has already cautioned against some of the new powers the Bill bestows and also the potential for private sector involvement in Integrated Care Systems (ICS), but also from the Conservatives’ backbenches itself. The 2012 reforms were deeply debilitating for the then coalition-government and it was (and still is) the most amended and debated piece of legislation in the history of Parliament. The current administration will dearly want to avoid the mistakes of the past.

Because there has been a pause on new legislation for so long, the NHS has had to largely operate on the edge of what legislation really allows it to do. Many of the reforms are what the NHS itself has been doing and advocating for over many years, but elements of the Bill are also deeply political. Javid will inherit a legislative landscape in which he, as Secretary of State, has powers to directly intervene in NHS England, local decision-making and abolishing arms-length bodies.

Number Ten is said to still be firmly behind the reforms, but that may change as the Bill passes through Parliament and if resistance to it is as visceral as in 2012. On a procedural point, the Bill needs to be at Second Reading before the Summer Recess if ICS’ are to receive statutory footing by April 2022. Given the parliamentary timetable and political pressures, that may well prove a tough early test for Javid.

Social Care

The Boris Johnson famously declared on the steps of Downing Street that he had a plan for social care in his very first speech as Prime Minister. Javid will have to work with the Prime Minister and the Chancellor on a long-sought solution to social care. Discussions are leaning towards the (2011) Dilnot proposals, which could mean a £50,000 cap on care costs.

Javid, as a former DCLG Secretary of State, will be familiar with many of the arguments on social care and the historic schism between the NHS and local authorities. With the Treasury worried about where the money is coming from, Javid’s time as Chancellor could mean there will be another voice arguing for more fiscal restraint.

New NHS England Chief Executive

A successor to Sir Simon Stevens, the current Chief Executive of NHS England, is due to be appointed next month, which Javid will be closely involved in as the new Secretary of State.

A key early test will be whether Dido Harding, who led NHS Test and Trace through much of the COVID pandemic and was previously NHS Improvement chair, is appointed to succeed Stevens. Harding has proved a controversial figure but is well connected to the Government and may well be less of a figurehead (and as strong-minded) as Stevens.

Another option may be to delay Simons’ departure; the rationale being that the midst of a public health crisis is not the time to have a new Secretary of State and a new NHS England Chief Executive. A delay of 6 months to a year would allow Javid to master his brief and effectively analysis all the candidates.

Conclusion

Javid comes Health and Social Care Secretary at quite an extraordinary moment and with a unique and unprecedented set of challenges facing the health service.

He will become the most high-profile Cabinet member with direction and say over millions of lives, not just now but in the years to follow. Whilst the vaccination programme is well advanced, Javid will have to make key and early decisions on how we learn to live with COVID-19.

His return is not all that unexpected, which may be somewhat surprising as he stood up to the then Prime Minister’s chief advisor, Dominic Cummings, on appointing his aides and summarily resigned from the government, to the surprise of Boris Johnson. His return catapults him not only back into the heart of government, but into our living rooms and into our daily lives. His success is our success and the ability to return to normal “as soon and as quickly as possible”.

 

The views expressed in this article are those of the author(s) and not necessarily the views of FTI Consulting, its management, its subsidiaries, its affiliates, or its other professionals.

©2021 FTI Consulting, Inc. All rights reserved. www.fticonsulting.com

 

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