Andy Cowper

‘Deputy succeeds boss’ might not normally feel like a ‘hold the front page’ type headline. But the announcement that Amanda Pritchard is the new head of NHS England – replacing Simon Stevens – reveals a lot about the state of the NHS and the future direction of the health service. Firstly, the process. Despite concerns that the race to succeed Stevens would be politicised, Pritchard’s appointment (which I revealed on Thursday, thanks to a spot of digital and logistical sleuthing) is understood to have been wholly free of political nudging. Some of the credit for this goes to Number 10 health advisors and some to Lord David Prior, NHS England’s chair and a former Conservative MP.

Dido Harding’s campaign to become the next boss of the NHS in England took a high-profile turn this weekend. ‘Sources close to Dido Harding’ (perhaps ones occupying the same pair of shoes) briefed the Sunday Times about the Conservative peer and ex-boss of the £37 billion Test and Trace scheme pitch as a candidate. (If appointed, the noble Baroness will reportedly resign from the Conservative party and take an indefinite leave of absence from the House of Lords.) Apparently, the health world’s favourite noble Baroness will end England’s reliance on foreign doctors and nurses if she replaces Sir Simon Stevens as the next head of NHS England.

You might think that a cabinet minister and privy councillor whose reputation for truthfulness had been brought into (very public) question would be inclined to keep their public utterances strictly on the straight and narrow. You’d be failing to allow for the enthusiastic approach of the Health Secretary. Matt Hancock used his presentation to today’s NHS Confederation Conference to try to explain that the five million-strong NHS backlog, claiming it was down to Covid-19. Asked about providing guarantees of funding to address the NHS backlog, Mr Hancock told the event that 'the virus is responsible, and the backlog is a consequence of the pandemic'.  https://www.youtube.com/watch?v=qRErV48sz5I This is, quite simply, untrue.

When Dominic Cummings, the Prime Minister’s former chief advisor, gave evidence to the Covid-19 ‘lessons learned’ joint select committee last month (over the course of seven hours) his revelations seemed explosive. Specifically, Cummings alleged that the health secretary Matt Hancock was guilty of incompetence, interference and repeated lying. He told the committee: ‘The Secretary of State should have been fired for at least 15 to 20 things, including lying to everybody on multiple occasions in meeting after meeting in the Cabinet room and publicly.’ ‘In the summer, he [Matt Hancock] said that everyone who needed treatment got the treatment that they required.

NHS England boss Sir Simon Stevens's final speech today was watched online by hundreds of health service bigwigs. But its main audience was much smaller. It was aimed squarely at just two people: Boris Johnson and Rishi Sunak. Stevens’s main message was about funding. The government, and, in particular, the Treasury, may not be thrilled once they wrap their heads around his statement on the five-million-strong (and Covid-predating) NHS backlog that 'when the health service is given the backing and the tools we need, we can deliver what's required'. Translated into plainer language, Stevens was saying: ‘Get your wallets out: this is going to hurt’.

In England, the NHS is run by an organisation with an identity crisis. It calls itself NHS England, but that’s just self-promotional branding. In law, it is the NHS Commissioning Board, created by Andrew Lansley’s controversial 2012 reforms which gave the NHS a high level of autonomy from direct government control. The NHS Commissioning Board was first run by ex-Communist Sir David Nicholson; then by a former Labour councillor and ex-New Labour special advisor Sir Simon Stevens, who steps down at the end of July. Based on that trajectory, a cynical observer might suggest that in the distant future even a former Liberal Democrat could one day get the job. But could the ‘NHS England’ top job go next to a prominent Conservative?

It was always likely that the evidence given by Dominic Cummings to the health and science joint select committee inquiry yesterday would have quite an impact. Cummings certainly has a flair for communication and a revolutionary zeal. On top of that, he has scores to settle when it comes to the Prime Minister’s conduct and his treatment of his former chief advisor. Interestingly though, one of the main targets of Cummings’s ire yesterday was Health Secretary Matt Hancock.

If social care reform were any deeper in the long grass of political priorities, it’d probably get mistaken for a hedgerow. It got a one-line reference in the Queen’s Speech this week, which does not even guarantee that the 'clear plan' promised by the PM in his first speech in the job will be published this year. Announcing ‘a long-term plan for social care reform this year’ has been a quaint annual government ritual since 2017. The Queen’s Speech also mentioned the need to clear the NHS backlog. Delays for treatment, already widespread before Covid-19 due to a decade of NHS funding increases lagging behind demand, are now the worst since reliable record-keeping began in 2007. And house prices are playing in to both of these problems.