Successive governments have promised significant reform to health and social care and have consistently failed to deliver. Now Health Secretary Hancock is narrowing his eyes and assuming more control in a disastrous power grab, argues Jack Mountney.

The Health Secretary Matt Hancock has masterminded a string of fatal failures and one big triumph since the start of the Covid-19 pandemic. The determined politician, who is currently relishing rare praise for his vaccine triumph, seems to think he is the right person to take more control over the NHS. He complains that when he tries to propose positive change, nothing happens!

This is massively foreseeable, as an economist overseeing a vast, complex organisation spending £130bn a year in England with 1.2 million highly qualified staff, what can go wrong?  The Health Secretary is using the cover of the pandemic to create a power shift. 

A leak of Hancock's proposals uncovered his scheme to take "enhanced powers of direction for the Government." This led to a swift cover up job in the weekend media, claiming the biggest health crisis for a century showed desperate need for drastic reform. It is a load of nonsense. Hancock has mentioned such reforms from the second he arrived in office, with some ideas proposed in the 2019 Conservative manifesto. Even Sir Simon Stevens, Head of NHS England, has been clawing back Whitehall's power over the system for several years. 

Any major shake-up presents valid issues over a new spell of bureaucratic shuffling in an organisation already damaged by the pandemic, filled with staff left shattered on the frontline. The timing is ultimately driven by politics and the Government's desire to pass through reforms quickly, so any controversy subsides before the next election. 

The Tories remain haunted by their failed reforms introduced by David Cameron's Government in 2012, which saw the creation of NHS England, scrapping of primary care trusts in favour of GP-led clinical commissioning groups to organise local services. Cameron later confessed his changes were badly handled and missed key issues of crumbling social care in an ageing society. Hancock's aim is to untangle the impact of poor reforms that devolved power and fragmented local services. 

Ultimately, politicians will always be held accountable for the NHS and how it deals with such events like the current pandemic. But Hancock's move is merely the latest squabble in the long battle between politicians and an army of staff delivering diverse local services, over how to deliver efficient and effective care with limited resources. Every rich nation is confronting similar dilemmas as demand soars due to the COVID-19 pandemic. 

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Hancock looks to gain public support with the populist ideology of rolling back privatisation. Yet the problem is not the profit motive in healthcare, as proved in sections of the NHS and European systems with better patient outcomes. It lies in poor commissioning, poor operators, disempowered patients, and inadequate politicians. For example, Hinchingbrooke Hospital in Cambridgeshire was briefly handed to a private firm and was routinely held up as an example of failure. Yet it has offered important lessons in innovation, procurement, and staff empowerment. 

I am aware that there has been a huge increase of terrible private provision in psychiatric services, with private firms conning the state and providing atrocious care, but ministers have not used their existing powers to stop them. The pandemic has also seen huge contracts handed out to MP's associates with a scandalous lack of accountability. These are political, not structural failures. 

Hancock's desire to speed up the effort towards greater consistency among local care and health services is of course correct. But there are grounds for caution. Social care needs to retain its own, localised character, not simply be controlled by the NHS. There is also a danger of politicians having too much control since they will continue to play their self-serving clannish games. 

Likewise, there was good reason to break the stifling and unaccountable grip of Whitehall by diverting more power to outsiders. If the Government really wants to build back better after the pandemic, more important reforms are needed.  

There is critical need for a social care reform. We have a rotten system, one that breaks rather than helps families. This was uncovered again by the pandemic. We need thorough change that delivers adequate services, drives out private corporations, ensures proper pay for staff and hands control to service users. This would relieve considerable pressure on the NHS. Instead, we have had Boris Johnson lying about his mythical plan for reform. 

We need to resolve persistent staff shortages in the NHS. This is always low down the list of a politician's priorities since the impact of reform occurs long after they have left office when it takes seven years to train a doctor. One suggestion is for an independent body to provide analysis and forecast for future needs. The issues are not always simply down to funding: billions are blown each year on costly agency staff. 

If Hancock really wants to seize control, then he should start proposing solutions to the damaging failures of social care, staffing, patient safety and psychiatric services.

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