A week into the job and Wes Streeting has been every bit as hyperactive as you imagined he would be. Anyone would think Labour had been waiting 14 years to have a go at running health and social care…
Of course these are the easy days. An introductory chat with the junior doctors is more straightforward than actually reaching a deal to end the strikes. Opening talks with the dentists about a new contract is a smart move, but reaching agreement on what that contract should look like might feel like pulling teeth. The next few weeks are a window that the new Secretary of State cannot afford to waste if industrial relations are to be genuinely reset.
The instruction that he wants joint submissions from DHSC and NHSE officials and that he is eager to hear conflicting opinions is likely to be the first step of many to bring the two organisations closer together, giving Streeting a clearer line of sight to frontline delivery. This is particularly important given the way he is seeking to frame thinking on the future of health and care.
There have been some important symbolic moves which begin to reveal how this framing will work. Visiting a GP surgery before a hospital may be a gesture, but it felt like an important one to those struggling in primary care, particularly when accompanied by signals about where any extra money might be prioritised (earlier in the pathway).
Saying that boosting economic growth will be a priority for his department has also earned a lot of approving nods (not least from the IPPR, who have championed this agenda). The role that health can play in growth, through cutting waiting lists and partnering with the life sciences sector, is increasingly accepted. However, weighing this against the short-term need to balance the books will not be easy. Just ask the Treasury, which has always struggled with this balancing act.
The Secretary of State’s first announcement that, “From today, the policy of this department is that the NHS is broken” is something that will chime with the experience of many who use or work in the NHS. It is certainly a ‘policy’ that is easy for the DHSC to deliver (it might be the most rapidly delivered policy in history…)
The ‘broken’ mantra does, however, mark an important philosophical shift. For a long time, leaders have seemingly found it difficult to acknowledge the reality facing many services (and therefore millions of patients). The acknowledgement that the NHS is broken is about as far away as it is possible to be from writing the service a birthday card (which, had a snap election not been called, would have probably been the communications focus in early July).
‘Broken’ also enables a different form of analysis of the problems facing the NHS and social care (presumably Wes Streeting decided that the latter part didn’t even need saying), opening up the consideration of more radical and urgent fixes. This brings us on to the news that Lord Ara Darzi will lead a review into NHS performance, sixteen years on from his Next Steps Review for the Brown Government. This is a precursor to the development of a new 10-year plan and will be used to inform some no doubt bruising discussions with both the Treasury on funding and the NHS on the need for reform. Now we are into the ‘broken’ era, punches will not be pulled.
The shift in the tone of conversation is the most significant development of the past week and has important implications for anyone seeking to shape health and care policy in this Parliament and beyond. Paul Corrigan – now back at DHSC after 20 years – has argued that the first essential first stage of the Blair-era reforms was winning the argument with the service itself that change was both necessary and possible. Only then could investment and reform be effective. Be in no doubt, Wes Streeting is gearing up to lead an argument with the NHS about the need for change. This is the stage where we are at. It will be a busy few months in health policy.
by Mike Birtwistle, Senior Counsel