David Oliver: A speech to be proud of?

A couple of weeks ago Matt Hancock, the Secretary of State for Health and Social Care in England gave a speech at the annual NHS Providers’ Conference. 

Unexpectedly, he popped up on my twitter timeline, urging me and others to read the speech in full.

Naturally, I did read the full text of the speech. It’s freely available on the government website. This wasn’t any old ministerial speech, but a major set piece designed to signal his intention and priorities for the NHS and only days before the Queen’s Speech on the 14 October. The title “How we build an NHS that’s there for every member of society” speaks volumes, especially in the run-up to a possible general election.

Hancock was clearly proud of it and keen to promote and defend it. So let’s look at what he did and did not say about the challenges facing the NHS and the big ticket solutions. 

By common consent the largest challenge facing the service right now is the clinical workforce without which service quality is bound to deteriorate. This he glossed over by referring to “The People Plan” (delegated to NHS national arms-length bodies) “which will be published later this year”. He mouthed scripted platitudes about “inspiring and engaging the workforce” without saying how. 

He also claimed that “Most of the additional £33.9 billion will be spent on people”. But this figure is highly contestable. The government has already been criticised for claiming that additional funding from 2018/19 to 2023/24 is a “record funding increase” when it is merely in line with average annual percentage increases up until 2012. But that figure took into account projected inflation which more accurately reflects additional spending power. It seems that Hancock had conveniently forgotten this inflation adjustment. Boris Johnson then repeated the £33.9bn figure in the commons during Prime Minister’s Question Time.

His speech only briefly mentioned public health and completely ignored public health funding and provision or policies to prevent ill-health or inequalities. It ducked the increasingly pressing challenge of social care funding and provision—perhaps because this would be mentioned in the Queen’s Speech. He discussed “wrap-around care and support we provide to elderly people and people with physical or learning disabilities” with no detail on delivery.

Come the Queen’s Speech, there was a re-announcement of the serially delayed Social Care Green Paper with no timescale for publication, let alone a resulting white paper or bill and a re-announcement of a £1.5bn injection for social care available to councils relying on councils raising more council tax from local residents. As I have argued here, this is a regressive approach, entrenching inequalities and inverse care between affluent and poor areas

Hancock did, in his speech promise a “Long Term Plan Bill” with legislative changes to support the NHS Long Term Plan. This focussed on a statutory footing for new structures such as integrated care systems and new permissions to move towards more integrated locality working, risk sharing, organisational mergers, removal of enforced competition and a move away from a purchaser provider split and traditional payment models. 

As NHS England leaders have called for this and critics of the long term plan have criticised reorganisation without legislation or public scrutiny, I can accept this—although the devil is in the detail and it’s not the kind of announcement to inspire anyway outside the NHS senior management cadre.

Hancock went on to renew his repeated commitment to better technology in the NHS, citing his creation of the new arm’s length body NHSX and a focus on “shared standards on governance, procurement and contracts, so that you can buy whatever you want, from whoever you want, as long as it’s safe, inter-operable and does the job”.

The jury is very much still out on these approaches. The revolving door between NHS Digital and NHSX senior posts and the health tech sector keen to do business with the NHS has raised questions. The premature over-promoting of still unproven technology, and relationships with organisations like Babylon Health, have raised eyebrows. We need more transparency, scrutiny, and far better evidence rather than blind faith and assumptions about the effectiveness of health technology innovations. 

Alongside legislation for reform and technology, the third element of Hancock’s speech involved commitments to capital expenditure on NHS buildings and facilities—which is certainly long overdue. 

However, his speech focussed on acute hospitals rather than other vital facilities in community and primary care, promising: “6 new hospitals, ready-to-go now, will start immediately, and another 34 new hospitals, in the pipeline, have been given the green-light, and seed funding, to develop their plans.”  

This is some way off the “40 new hospitals” Hancock had been promising only a few weeks before. Nor are they brand new builds but upgrades. There was a commitment to “multi-year indicative envelopes” for capital funding rather than one off payments. And more “streamlining.” Again, credible detail was absent. Nor did the Queen’s speech shed more light. Both the Nuffield Trust and the “Full Fact” site have debunked the original claims. 

Overall, Hancock’s proud defence and promotion of his speech seems incongruous given the key policy areas completely ducked, and the many details missing. 

Still, he did ask me to read it properly and I was happy to oblige.

David Oliver is a consultant physician in Berkshire and writes the weekly BMJ “Acute perspective” column. Twitter @mancunianmedic 

Competing interests: None declared