What does a BoJo Premiership mean for the NHS?

PB Deputy Managing Director Dan Jones writes…

Dan Jones

After a leadership campaign that seemed to last forever, the inevitable happened – Boris Johnson became Prime Minister. The new PM did not mess around when it came to putting in place a new team, Boris’ cabinet changes were the biggest overhaul ever seen outside of a General Election, he is a man in a hurry to get things done. This rapid-fire renovation of Cabinet is representative of an administration in campaign mode and a clear demonstration of his intent.

What will this likely mean for the NHS? Secretary of State Matt Hancock was one of the few Cabinet members to remain in place following the reshuffle. Caroline Dinenage also keeps her job as Minister of State where she is joined by Chris Skidmore. At the lower levels, reality TV star Nadine Dorries joins passionate healthcare campaigner Jo Churchill as junior Ministers while Nicola Blackwood continues as Health Minister in the Lords.

The relative stability in the health team means we are unlikely to see a dramatic shift in healthcare policy. There are reports that the Government will focus on three areas – NHS, police and Brexit. On the NHS Mr Johnson will want to shut down the noise around the “£350m extra per week”, which will probably mean increased funding without major reforms. Hancock set out his priorities early in his role – workforce, technology and prevention and it is unlikely we will see him setting out a different agenda.

The reality for the NHS is that external factors will influence what happens in the short term, with the resolution of Brexit and a potential General Election shaping everything. One of the Government’s first major announcements was the extra £1.8bn for capital expenditure in the NHS. Leaving aside what is becoming a heated debate about whether this money is completely new money, existing money repurposed or somewhere in between, this announcement is significant.

If we are on campaign footing, the obvious thing to do is pump additional finances into the NHS. However, the danger of pouring money into the existing system is that it can quickly get swallowed up with the public seeing very little difference to their care. Specifically allocating the money for capital expenditure means the money has to be invested in building projects and improvements. These sort of projects are highly visible to the public. Announcements of shiny, new hospital wings and refurbishments are more tangible than the news the NHS will ‘increase spending by 2.4% above base rate inflation of the next four to five years.’  Anyone who has driven up and down the M11 in the last few years will have seen this in action as the new Royal Papworth Hospital was built.

The second issue for Mr Hancock is the Long Term Plan. Properly implementing the proposals included in it will require legislation. Issues such as the statutory footing of Integrated Care Systems and integrating purchasers and providers will be difficult to achieve whilst the current legal framework is in place.

Given the Labour Party has made it clear they would fight against legislation on this issue, it looks increasingly difficult for the Health and Social Care Secretary to make progress. With a Parliamentary majority of one, a potentially disgruntled group of leavers on one side and a disgruntled group of remainers on the other, attempting to push through a significant NHS Bill might prove too difficult and certainly not a fight worth taking on in the current climate.

So what does all this mean? With Mr Hancock’s passion for technology and Mr Johnson’s (and Dominic Cummings’) desire for high profile positive stories, don’t bet against further announcements related to infrastructure and capital equipment – we could well end up with proton beam therapy at every District General Hospital! In the meantime, the need for fundamental reform to our health system will have to wait a little while longer.