Matt Hancock’s speech on the future of healthcare is unlikely to survive contact with reality

Matt Hancock’s 30 July speech, boldly titled ‘The Future of Healthcare’, was his first for some time, and he appeared in no mood to waste the opportunity. This was an ambitious speech, ranging widely across his portfolio as secretary of state for health and social care and not shying away from controversial issues that have dogged his predecessors for decades.

In a little over 6,500 words he pledged “bold reforms” of social care funding, oversight and accountability; integration of health and social care; that consultations should be remote by default; and that “bureaucracy will not be coming back”.

It is good for ministers to set out a clear vision and the beginning of a parliament is certainly the best time to tackle politically difficult issues. And there is a place for such ‘broad-stroke’ speeches – not every ministerial utterance needs to grapple with nitty-gritty details. But the difficulty will come in turning these high-level objectives into practical proposals.

It’s unclear whether Hancock’s vision can survive contact with political reality

Most of the headlines this morning have focused on Hancock’s pledge to make GP consultation remote by default, with the Royal College of GPs questioning whether this would be in the interests of patients.[1] Yet, this is probably one of the easier to achieve elements of the speech. The use of video and online consultation has grown rapidly during the pandemic, with 85% of practices offering online consultations at the end of May, versus less than 30% at the beginning of March. Whether or not it’s possible for consultations to become remote by default, it’s certainly true that there is much greater scope for patients to contact clinicians via telephone, video and online.

In short, getting GPs on Zoom may prove to be the easiest part of Hancock’s plans – it’s much less clear that the government can realistically hope to reform social care and greatly improve integration with the NHS.

In his first speech as prime minister, Boris Johnson claimed to have prepared a “clear plan” for fixing social care. Yet a year later, there is no plan to be seen. The recent appointment of Camilla Cavendish, the former director of policy in No.10, to develop proposals certainly suggests a seriousness of purpose but the politics of funding social care are notoriously tricky. Previous proposals have been labeled as a “death tax” or “dementia tax”, and it remains to be seen how the government will raise more money for social care while enabling people to keep their homes and without breaking its election pledge not to raise income tax, national insurance or VAT. The government may have an 80+ seat majority, but that could disintegrate very quickly if the government decides it must contradict a manifesto commitment barely a year old.

It’s a similar story with better integration between health and social care. Long the holy grail, the quest is fraught with political danger and practical difficulties. Efforts at more collaborative local planning via Sustainable Transformation Plans (latterly Sustainable Transformation Partnerships) and Integrated Care Systems have had mixed results. Hancock noted in his speech that “national healthcare institutions are too siloed, in many cases by law under the 2012 [Health and Social Care] Act”. Health bodies have done their best to work around the 2012 Act but fundamental reform will require new legislation. Few issues are as emotive as the NHS and it’s not clear that the government has the appetite for the fight that reform may entail with opposition parties, unions and the public.

Hancock’s talk of handing the initiative to health professionals appears at odds with No.10’s desire for control

Perhaps the most intriguing part of Hancock’s speech was his focus on trusting health and social care professionals to “use their professional judgement”. This is interesting not because it’s particularly innovative – people have been saying such things for years – but because it is in complete opposition to the apparent modus operandi of No.10. 

Rather than letting go, the government wants to take back control of healthcare. The last few months have seen multiple reports in the press that the prime minister – and his advisers – believe that the independence of NHS England should be reduced. Government sources have even complained that Public Health England is too far beyond ministerial control, despite the fact that it is an executive agency of the Department of Health and Social Care and thus directly accountable to Hancock.

The case for giving the health secretary greater power to direct the health service’s many bodies and organisations is weak, so Hancock’s approach is welcome here. But the lofty objective to unleash the expertise of professionals may well prove impossible to square with political realities once translated into detailed policies. As with much of the speech, Hancock has raised expectations that will be difficult to meet.