The new Secretary of State for Health and Social Care, Steve Barclay, has taken over a very challenging brief in less than ideal circumstances. Whether he is in it for the long haul, or will just be a short-term caretaker while the Conservative party chooses a new leader, the new Secretary of State has some tough decisions to make.

Steve Barclay was a minister in the Department of Health and Social Care through most of 2018 until he became the Brexit secretary. Returning now as Secretary of State, he inherits a health and care system that feels light years away from the pre-Covid world, and not in a good way.

The challenges facing the NHS couldn’t be more obvious. Back when he left in 2018, 2,431 patients had been languishing for more than a year on the waiting list. That number now stands at 323,093. Back then, 259 patients waited for more than 12 hours in A&E to be admitted after the decision was taken that they needed a bed. That number now stands at over 19,000. Public satisfaction with the NHS has dropped back to the low levels of the 1990s, and satisfaction with GPs has fallen even further, to by far its lowest point since records began in 1983.

The new Secretary of State also took over the reins just days after the government’s flagship reforms to the NHS were enacted. On 1 July across England, 42 new Integrated Care Boards (ICBs) became statutory bodies, part of the most far-reaching NHS reforms for at least a decade. The legislation sweeps away much of the pro-competition framework that had formed the basis of the NHS for decades, and while supported by many NHS leaders, they will consume a lot of effort if they are to work and achieve the aim of a more collaborative and integrated health and care system.

Rarely if ever has the NHS faced such far-reaching reform and such deep performance challenges at exactly the same time. This means the new Secretary of State should avoid the temptation faced by many of trying to make a mark in a hurry. While the health service is trying to implement previous reforms, don’t launch more – especially if the last lot are your own government’s.


[ See also: The NHS is under strain from Covid once again ]

So where would health and social care leaders suggest the Secretary of State focus his efforts? The great majority would say the workforce, as extensive and deep staffing shortages undermine the ambitions for a better system – and that includes all the hopes of recovery from Covid. Frustration among NHS staff combined with a cost-of-living crisis will give the new Secretary of State his first big choice, as within weeks we expect the pay review bodies to recommend a pay rise that isn’t affordable based on current spending plans. He must either reject that, ask for more money, or pare back NHS commitments just as the service struggles to meet demand.

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Beyond the thorny issue of pay, the health and care system has struggled on for years without a comprehensive workforce plan to tackle its deepening staff shortages. Sajid Javid did commission one, due later this year, and getting this plan over the line may come as a personal challenge to Barclay. He has worked for far longer in the Treasury than in health – over two stints either side of his time in health – and HM Treasury’s long-standing opposition to such a plan (wrongly fearing it might be expensive) is well known.

Where else should he focus? His title says it all: Secretary of State for Health and Social Care. Sometimes it’s too easy to replace “health” with “the NHS”, yet the NHS primarily treats those who are ill, rather than preventing them from getting ill in the first place. Focusing on this wider health agenda, looking at prevention and public health, would also give a much better chance of fulfilling the levelling-up agenda of reducing England’s long-standing health inequalities. It’s true that some of this prevention agenda pays benefits in the longer term, so may not be attractive to someone wanting results fast (the exception is ensuring the country is ready for more waves of Covid or flu).

For other, quicker wins there is unlikely to be any better place to look than the social care element of his job. The government deserves some credit for having passed long-term social care reform, but this has left the service still in a short-term crisis of inadequate funding and workforce shortages at least as serious as those in healthcare. Aside from the hurt this causes those reliant on social care, it is also damaging NHS performance as hospitals struggle to discharge patients safely to home or community care, leaving beds filled with people who no longer need to be in hospital. To tackle this will either require some painful re-prioritisation within his own budget, or a visit to the new Chancellor for more money.

For the sake of the NHS, social care and people who use it, one hopes that Barclay’s recent experience at HM Treasury may help the Department for Health and Social Care sharpen its case if he chooses to ask for more for social care. The same holds true should he aim to overcome any resistance from the new Chancellor to a proper workforce plan for health and care.

This article was originally published on 7th July 2022.

[See also: Who will replace Boris Johnson as Conservative leader?]