The writer, a former head of the Number 10 Policy Unit, is a Harvard senior fellow
To avoid it running on a ghastly loop in my head, I have refused to watch the video of our former health secretary in a steamy clinch with his aide. I failed, though, to turn off the radio in time before the justice secretary intoned that, to paraphrase, flouting standards doesn’t matter because the prime minister is popular. Thanks guys, (and this is very much a government of guys), for making me feel so cynical.
The only upside of this debacle is that it makes the end of Covid restrictions on July 19 a near certainty. Sajid Javid, the new health secretary, has arrived at the perfect moment to earn backbench applause for declaring that “we must learn to live with Covid”.
Javid’s return to the cabinet tilts the balance towards the libertarian. Six years ago, I watched him present Ayn Rand’s The Fountainhead to a parliamentary film society. Describing it as a very important movie, he admitted to regularly revisiting the courtroom scene in which Gary Cooper, playing a visionary architect, extols the virtues of the individual against oppressive power. It’s a powerful scene, though long-winded, and Javid admitted that his wife got tired of hearing it.
Javid’s small-state conservatism makes him a natural ally of Rishi Sunak, the chancellor who was previously his junior minister. But that very alignment may, ironically, end up with him getting more money out of the Treasury for the NHS.
The health secretary’s in-tray looks more daunting than at any point since 1945. For decades, we’ve been warned that the NHS was on its last legs. Now, for the first time, I fear it’s true. The backlog of non-Covid cases is overwhelming. Almost 5m people are waiting for treatment and there is no convincing plan to handle it.
Staff I speak to are demoralised and burnt-out. GPs have been retiring in droves for several years, partly to avoid paying tax on their pension pots. Infection control measures for Covid-19 have reduced hospital capacity. I cannot see how business as usual will deliver anything near to what is required.
Winter is coming to this government, and not only because it is luxuriating a little too much in its majority. On top of the treatment backlog and future Covid cases, health leaders expect flu to resurge in a population which now has lower immunity as a consequence of lockdown. The NHS usually runs “hot” from November to March. This time around it will be boiling.
It’s all horribly reminiscent of the early 2000s, when waiting lists were lengthening into years rather than months. The Blair government poured money into staff and equipment, and made reforms to drive up efficiency, for example paying private hospitals to perform elective surgery.
Javid will not want to waste money. But he will have to pay at least some staff more than the 1 per cent increase they have been offered, invest in more diagnostics to speed up treatment, radically improve management and stop unnecessary form-filling creeping back after the pandemic. The Treasury hates hypothecated taxes. But there is a case for a one-off tax to help the NHS avoid a doom loop in which we never catch up.
Javid must also see the bigger picture. When he was chancellor, he will have been shown the scary graphs predicting that demand for healthcare and welfare is set to consume an ever greater share of public expenditure, as an ageing population suffers increasingly from chronic long-term conditions which consume two-thirds of the health and social care budget. This will cripple Britain unless we act earlier to keep people healthier. The NHS has paid lip service to prevention: now is the time to turbo charge ways to help people lose weight, give up smoking and get fit.
These twin issues — tackling the backlog and reducing the pipeline of chronic disease — will require a ruthless focus. For all Javid’s quiet charm, he is also dogged. His father worked double shifts as a bus driver after arriving from Pakistan with £1 in his pocket; the young Javid made it into banking.
This is Javid’s sixth cabinet job in seven years. He has been a cautious minister, having never had much time to get stuck in. But we may be about to see Javid unplugged. He resigned rather than agree to let his aides be sacked by Dominic Cummings. Having been out of the trenches for the past 16 months, he is fresh and untainted by mistakes.
Javid is already arguing with the prime minister over an imminent reorganisation of the health and care system. He needs to appoint a new CEO of NHS England and he must break the impasse between the chancellor and prime minister over social care.
Not everything will go his way. But the big question is whether he and Sunak can work together to match spending on both health and care to intelligent reform. Prime ministers tend to leave the mind-boggling complexity of health to their secretaries of state — but they do know that the NHS can be a vote loser, if things don’t go right.
Ideally, Javid would reignite some of the community spirit we shared in the first wave of the virus. For even as we embrace summer and welcome liberation, the health service will continue to be on a war footing. When so many people have tried to preserve the NHS by not requesting help, it was worrying to see doctors warn last week that A&Es were seeing record numbers of children with mild fevers which didn’t need more than paracetamol. We are all still in this together. Sadly, it hasn’t felt like that lately.