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The future of the NHS and social care green paper are the big issues in Hancock’s in-tray

The challenge for any health secretary is to keep focused on the long-term agenda, even when fire-fighting urgent and visible care needs.

Matt Hancock, the new Secretary of State for Health and Social Care, must use the NHS's recent 'birthday present' to pave the way for long-term change, says Lucy Campbell.

Being Health Secretary is one of the toughest jobs in Government. Matt Hancock has come into the position with two big issues in his in-tray: how to spend the ‘birthday present’ money for the NHS and what to do with the long-awaited and urgently needed social care green paper.

The new Health Secretary needs set out a 10-year plan for future NHS funding

On the eve of its 70th anniversary the Prime Minister announced a new funding settlement for the NHS – the ‘birthday present’. There are still questions government needs to answer about this money – most significantly where it will come from – and Hancock has to quickly get to grips with his brief in order to create and implement a 10-year plan to capitalise on this additional funding.

The Prime Minister’s vision for the NHS includes improving cancer outcomes, greater equality between mental and physical health, growing the workforce and shortening waiting times. The NHS is also expected to further eliminate waste and make efficiencies.

Changing how the NHS functions can be difficult. In our Ministers Reflect series, Ken Clarke warned "you can declare war more peacefully than you can reform a healthcare system". A recent NAO report noted that it is all too easy to divert funding to addressing short term and frontline issues, rather than implement long-term change. But as Hammond has warned ministers that this is a one-off uplift which other public services cannot expect, it’s more important than ever that the NHS is able to make the most of its additional funding to produce long term change.

There are steps Hancock can take to smooth the process. Government should make the underlying assumptions for its efficiency plans publicly available and open to testing for independent experts. The Government needs credible and measurable suggestions about what can be achieved, and by when, if it hopes to meaningfully change how the health service functions.

The change in Health Secretary must not delay autumn's social care green paper 

In the midst of the NHS birthday celebrations there was another, quieter announcement. The publication date for the green paper on adult social care for older people – which was initially meant to be delivered in the summer 2017 – was delayed yet again to autumn 2018.

We have warned that social care is stuck in a ‘cash, crisis, repeat’ cycle. Funding has fallen by 5% since 2009/10 and government has responded to pressures with sticking plasters and cash injections. Councils are increasingly reporting the financial strain of protecting their legal social care duties.

In the last 20 years there have been five green or white papers and four independent reviews into social care, all of which failed to transform the service, as former Health Secretary Jeremy Hunt recalled recently. Proposals in the 2017 Conservative manifesto to change the service’s funding were much maligned as a ‘dementia tax’ and subsequently dropped. For decades there has been a collective political failure to address the issues in social care. The green paper cannot be pushed back again, especially after the Government has committed to increasing funding for the NHS.

The challenge for any health secretary is to keep focused on the long-term agenda, even when fire-fighting urgent and visible care needs. Getting to know your brief, and the complexity of the health and care system, is the most common recommendation former health secretaries provide for a new incumbent, before they take on one of the toughest jobs in government. 

Former Health Secretaries have shared with the Institute for Government their reflections and advice on how to be effective in the role.

May government
Public figures
Matt Hancock
Institute for Government

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