Matt Hancock’s Ministers Reflect interview is not the whole picture of his time as health secretary

Matt Hancock’s Ministers Reflect interview paints an interesting picture of his time as health secretary. Recounting his experiences of managing the NHS and adult social care, Hancock describes a set of priorities for the NHS that closely align with the Labour government’s. Recalling his role in the government’s Covid pandemic response, he is vocal about his successes both before and during the pandemic. Hancock is right to be proud of his achievements in government, but as with all our Ministers Reflect interviews, his recollections only present one perspective.

The pandemic frustrated Hancock’s ambitions to reform the NHS

Hancock will be remembered for his response to the Covid-19 pandemic. But he was secretary of state for almost 18 months before 2020. In his Ministers Reflect interview, Hancock describes his three priorities during that time as “workforce, technology and prevention” and says he has “enjoyed seeing that they’re Wes Streeting’s three priorities now”.

Seen another way, Streeting designating prevention and digital technology as two of his three shifts shows how little progress Hancock and his Conservative successors made on problems that have foxed governments for decades. Under Hancock’s watch the NHS continued the long-term trend of funnelling an ever-greater proportion of its budget towards acute hospitals while cutting more preventative areas of spending like the public health grant.

Hancock told the IfG how Theresa May instructed him to digitise the NHS because he’s a “digital chap”, but there was little change in the rate of technological adoption. There was a small increase in the proportion of trusts using electronic patient records. But that process was piecemeal and fragmented – an approach which has subsequently made it difficult for different parts of the health system to communicate. ⁸ Alford J, Patients at risk because NHS hospitals using different record-keeping systems, Imperial College London, 6 December 2019, www.imperial.ac.uk/news/194269/patients-risk-because-nhs-hospitals-using/

Hancock’s report card on the workforce is also mixed. He oversaw the beginning of the recent expansion of hospital staff and direct patient care staff in primary care. But he and then chancellors Sajid Javid and Rishi Sunak must also take responsibility for deteriorating pay that contributed to the worst bout of industrial action in the NHS’s history. Maybe his biggest staffing failure was in general practice: the 2019 Conservative manifesto committed to hiring 6,000 more GPs, but there were 696 fewer working in the service by the time of the 2024 general election.

Arguably Hancock’s longest lasting NHS legacy is the 2022 Health and Care Act, initiated during his tenure, but passed after he left government. That legislation put integrated care systems (ICSs) on a statutory footing and defined the current organisational structure of the health service. The first few years of ICSs existence have been rocky. But if they do eventually fulfil their intended aims, Hancock deserves some credit.

Hancock should accept responsibility for Covid failures, alongside praise for successes

Matt Hancock was at the centre of the government’s Covid response for 15 months, taking crucial decisions about testing, vaccine development, and how to administer a system that was woefully ill-prepared. Without doubt, that is an unenviable task. Maybe unsurprisingly, Hancock describes the development of the Covid-19 vaccine – undoubtedly the government’s greatest success during the pandemic –as his proudest achievement. While seeking to claim credit he also acknowledges that “it was a huge team effort”, referencing work by the University of Oxford and the Vaccine Task Force. But some of those involved in the process have been less than complimentary about Hancock and his role, with Dr Clive Dix (one time chair of the Vaccine Task Force) describing Hancock as “a headless chicken” who “didn’t take time to understand anything”. ¹¹ Sky News, Matt Hancock is 'two-faced' and 'was like a headless chicken' during COVID vaccine drive, 5 March 2023, https://news.sky.com/story/matt-hancock-is-two-faced-and-was-like-a-headless-chicken-during-covid-vaccine-drive-12827051

Watch Matt Hancock's Ministers Reflect

Hancock described his struggles navigating a way through the centre of government at the start of the pandemic, blaming the Cabinet Office as a block on “things that needed happening” and identifying Dominic Cummings (then Boris Johnson’s chief adviser) as a particular source of chaos. Hancock was in a difficult position, responsible for driving the response to a crisis that touched upon issues far beyond his department’s remit. It is understandable, given the chaos at the heart of the Johnson government, that Hancock struggled to find support for his plans, but his interview also reveals the government’s difficulty in balancing competing objectives – and the fact that even a departmental secretary of state, trying to lead a response to a crisis, can struggle to get other departments on board without the prime minister’s support.

Arguably Hancock’s most controversial decision was to discharge patients from hospitals into care homes without testing them for Covid. The high court ruled that policy as unlawful in 2022, ¹² Booth R, Covid care home discharge policy was unlawful, says court, The Guardian, 27 April 2022, www.theguardian.com/world/2022/apr/27/covid-discharging-untested-patients-into-care-homes-was-unlawful-says-court  but Hancock claims he couldn’t “see a better way of doing it in that moment”. He says that decision came with strong support from Simon Stevens (then CEO of NHS England), and it is arguably no surprise that the interests of the NHS took precedence over those of social care – it follows a long-standing dynamic in British health policy. But perhaps Hancock could have done more to advocate for the adult social care sector, which has no single voice in Whitehall – unlike the NHS.

The pandemic was a chaotic time, with both the centre of government and the NHS struggling under pressures for which they were ill-prepared to respond. As Hancock describes, decisions were taken at speed and with incomplete information, while ministers and advisors pursued their own priorities. Hancock’s interview with the IfG sets out his view on why he took the decisions he did and what could be done better in similar circumstances. But this will only ever be one view, and it is for the Covid inquiry to draw out the full picture and learn lessons for the future.