Daily Insight: Getting off on the wrong foot

“A real nightmare, vindictive, arrogant, a bully, hostile to the NHS and all its works, a micro-manager of the wrong things, views NHS management as bloated and profligate.”

Our editor Alastair McLellan kicks off his editorial with this hard-to-ignore selection of quotes from senior NHS leaders about the latest health and social care secretary, Steve Barclay.

The appointment came hours after Sajid Javid – health secretary since June last year – announced his resignation, saying in a letter to Boris Johnson that he “can no longer, in good conscience, continue serving in this government” and that Mr Johnson had lost his confidence.

Mr Barclay served as a junior minister in the Department of Health and Social Care between January and November 2018. In February 2020 he was made chief secretary of the Treasury – the official holder of the government’s purse strings – a role he held until September 2021.

“He made few friends in the NHS during those periods,” writes our editor. “His ‘hard-edged’ style rubbed people up the wrong way, but the greatest cause of frustration was his oft-repeated view that, in the words of one of HSJ’s senior sources, the NHS was a “bottomless pit, resistant to change and unaccountable”.

“HSJ wishes Mr Barclay the best in his new role,” writes Alastair, “and advises him that he has a lot of bridges to build. Health secretaries who have tried to force the NHS to do things it doesn’t want to do, at a pace it thinks is unworkable, suffer a sorry end.”

Change of heart

Just a few months ago integrated care systems were asked to draw up plans detailing how they would treat 10 per cent more patients than they did before the pandemic. A challenging target in itself, it was only a staging post on the way to the health service doing 30 per cent more activity by 2024-25.

As HSJ reported earlier this week, hitting the goal has proved difficult due to covid, social care issues and urgent care pressures. Now HSJ has learned that NHS England is set to give up on the requirement entirely, so that ICSs which are failing the target aren’t financially penalised.

As one ICS CEO put it, keeping the policy unchanged would see NHSE accumulate a “massive pile of cash” and lowering the target would be a straightforward way to push it back out to ICSs.   

Changing the goalposts could be politically contentious – not least because the Treasury provided more than £8bn in elective recovery cash over the next three years in exchange for the NHS committing to the targets. It could also cause consternation at the DHSC, where newly appointed health secretary Steve Barclay is widely regarded as an opponent of supposed NHS profligacy.