Hancock’s Summer Homework
PB Account Executive Tom Doughty writes…
Amongst the madness that has taken over Westminster over the past month, Matt Hancock’s move to the Department of Health and Social Care has gone relatively under the radar. Having been promoted just two weeks before parliamentary recess, there will be little doubt Hancock was amongst the list of Ministers who were thankful for Parliament’s summer break.
Tasked with getting to grips with the structure of the NHS and social care, Hancock now has five weeks to do some homework and prepare himself for leading one of the most important departments in Government.
But whilst he may be faced with this daunting task, there is one saving grace. Hancock inherits the Department of Health and Social Care on the back of a new funding settlement which will see an extra injection into the NHS of £20.5bn in real terms per year for five years, equating to an average of 3.4% per year.
Come the autumn, the new 10 year plan for the NHS will be due. This important document will lay out the way the NHS and social care will be integrated, will aim to improve outcomes and will explain how this new funding will be spent.
The funding will certainly give Hancock a leg up but he will know that this is surely it. Any further increases in funding over the next five to ten years are likely to be modest, and he will know that not all of the NHS’ problems can be fixed by the settlement.
The NHS has many issues: cancer survival rates lag behind European counterparts, it has high regional inequalities and there are productivity and efficiency savings to be made. Within his three priorities -prevention, workforce and technology – Hancock will surely be hoping to tackle some of these key problems.
It is important to note that the money granted to the NHS is still less than what many think is required. The Institute for Fiscal Studies have said that just to keep the NHS providing the level of service it does today will require a spending increase on average of 3.3% a year for the next 15 years. Even larger increases in the short run would be needed to address immediate funding problems.
This means that his plans for integration and transformation must be stuck to, something which we cannot always say has been the case since the Health and Social Care Act of 2012.
The new NHS structures that have developed from the Five Year Forward View, such as STPs and ACOs, may well be updated in the upcoming 10 year plan towards the creation of even more integrated bodies. Some STPs have already undergone further transformation to form Integrated Care Partnerships, or Accountable Care Systems, newer types of collaboration which give more power to local organisations to provide better and more joined up care. But the development of STPs has not been easy. How exactly to integrate them further, what form they will take, and over what time period are big questions that Hancock faces over the summer.
Even before the summer break, Hancock made it clear that encouraging collaboration will be a key focus of his tenure. Therefore, it is likely his agenda will continue to reverse the competition encouraging policies seen under Jeremy Hunt, which were used in times of slow funding.
Integration and devolution will help Hancock’s money go further, for example by providing care at home and removing barriers to services. But he is still faced with a choice over what services to prioritise. Mental health, social care, and sexual health are three vast areas which could all use a sizeable funding increase just on their own.
According to Forbes in 2015, the NHS was the world’s fifth largest employer, making it the largest non-military publically owned organisation in the world. The sheer size of the NHS would make it difficult for any government to fund it fully. Reform is the answer, and public and private partnership, in integrated and devolved local bodies, should be a key aim of the 10 year plan.
One final area for Hancock to consider might be how the Conservatives can regain the NHS as a political asset and make themselves the ‘party of the NHS’. Almost a decade of slow funding has done serious damage to the Tories’ perceived ability to run and look after the NHS. If Hancock can work out how to re-motivate the healthcare workforce, how to maximise patient choice, and how to legitimise public/private partnership, he would go a long way to undoing some of the damage.
Hancock has a lot to grasp, in a very short space of time. Taking on this job with little prior knowledge will not be easy. That’s why this few weeks of preparation, ahead of what could be the defining document of his tenure, will be so important.