This Week: May at 10 by Sir Anthony Seldon
Why it matters: The latest deep dive by Britain’s leading political historian examines Theresa May’s time as prime minister and details how her attitude and approach to the NHS changed during her time in Number 10.
Theresa May “didn’t understand what had gone wrong [on the NHS] or how to put it right” when she entered Number 10, according to Sir Anthony Seldon.
She was instinctively anti-reform because she knew “previous attempts… had backfired”, while at the same time “hyper-sensitive to the possibility of a winter crisis”.
Sir Anthony also claims she “did want to see increased funding for the NHS”, something that will surprise those senior NHS figures who met with her at this time.
Indeed, her first budget in 2017 only produced a £2.8bn increase for the NHS, despite the PM’s own policy unit — and NHS England chief executive Simon Stevens — arguing for £4bn.
Sir Anthony quotes Mrs May as saying: “The problem with conceding to what Simon Stevens is always demanding is that we end up putting the money into short-term solutions like reducing waiting lists rather than systematic improvement, or into preventative medicine or mental health.”
Then health secretary Jeremy Hunt apparently agreed with the PM.
The settlement “ended up riling the NHS rather than pleasing them” recalls special adviser Alex Dawson.
However, towards the end of the year, Mrs May’s attitudes had begun to change.
The PM felt the Conservatives had got into a “ridiculous position” on the NHS as a result of being banned from discussing it by campaign guru Lynton Crosby during the 2015 and 2017 elections.
NHS performance was continuing to worsen, Mr Stevens was again growing vocal and House of Commons health select committee chair Sarah Wollaston “began to call for a Royal Commission, which scared No10… and No11 witless”.
On 7 February 2018, Mrs May was shown polling by Mr Dawson which demonstrated that people were “prepared to pay extra taxes to fund improvements” to the NHS.
Sir Anthony becomes a little too credulous at this point, taking at face value statements like “the PM started to think that the NHS leadership needed to be treated in the same way as the police: it needed reform to become much more biddable”.
There had been a plan to “announce an inquiry into the NHS” at the end of 2016, similar to the one conducted into higher education, but this had been “overruled by the Treasury,” says Sir Anthony.
Now the idea was reheated as a 10-year NHS Plan.
This would apparently enable Number 10 to “hold the NHS to account for delivery”.
The truth — as most HSJ readers will know — is that by 2018 the government had little choice but to significantly increase NHS funding or face a total service melt-down and the resulting political backlash. Chancellor Philip Hammond tried to hold out for a three-year settlement, but finally accepted it had to be five.
The NHS plan — full of good ideas as it is — was still sophisticated window dressing for dragging the NHS out of the traditional public sector spending round to be given a 70th “birthday present”. A fact instantly recognised by savvy commentators like Spectator editor Fraser Nelson, who was both admiring of the conjuring trick pulled off by Mr Stevens and Mr Hunt and, irritated that the spoilt NHS could get even more cash.
From the start of Mrs May’s premiership, Sir Anthony says mental health was an area in which she was prepared to “take risks”. He claims Mrs May won “an 18-month battle from 2012” with Mr Hunt to get David Cameron’s government to take mental health more seriously.
Mrs May arranged for Sir Simon Wessely, former president of the Royal College of Psychiatrists, and Poppy Jaman, founder of Mental Health First Aid, to address Cabinet for 45 minutes.
Most ministers were attentive, apart from foreign secretary Boris Johnson “who gave the impression that he thought it was all nanny-state stuff and made sotto voce asides throughout”.
No surprise then that, according to Sir Anthony, those working on a subsequent project to improve black, Asian and minority ethnic mental health did their best to make it “Boris proof”.
Sir Simon is glowing in his praise for Mrs May’s interest in and support for “the most intractable aspect of mental health, one in which there were the fewest votes: severe mental illness”. Nobody since Stephen Dorrell, Conservative health secretary between 1995 and 1997, “had taken such a real interest in the most difficult part of the whole spectrum”, the former Royal College of Psychiatrists president tells Sir Anthony.
With tears in her eyes
Perhaps the most illuminating section of the book is the one on the disaster which befell Mrs May’s proposed social care reforms in 2017.
Here was an issue on which — according to Number 10 deputy chief of policy Will Tanner — Mrs May believed “people felt let down by politicians” and that it was her duty to act.
Her senior communications adviser Fiona Hill told the PM it was a mistake, but Sir Anthony quotes Mrs May as saying: “I know I’ll have to use up some of my political capital, but this is the time to do it.”
As Ms Hill rowed with Mrs May’s other chief adviser Nick Timothy, the PM — with tears in her eyes — banged the desk and said: “We’re going to do this.”
When — as Ms Hill predicted — the negative media coverage of the social care proposals provoked widespread panic among Tory MPs, Mrs May did nothing to calm the storm.
Sir Anthony notes she simply could have said: “Nobody would lose their homes during their lifetime and they would be left with at least £100,000”. But she didn’t and, as Sir Anthony remarks later in the book, as far as Mrs May was concerned “social care was dead in the water”.
‘Over my dead body’
One intriguing side note was that the first draft of the 2017 Conservative manifesto contained a proposal to introduce “social insurance”. Mrs May vetoed it, saying “over my dead body”.
The section on the January 2018’s botched reshuffle confirms Mrs May had intended to replace Mr Hunt with the “solid” Greg Clark to calm things down after the junior doctors strike. However, Sir Anthony has also discovered that Mr Hunt “had spoken to No10 before the general election about wanting to be moved”, and that rumours swirled in the corridors of power that he wanted the job of deputy prime minister.
As that possibility receded, Mr Hunt began to change his mind, “without notifying Number 10”. He was, recounts May at 10, increasingly keen on “becoming the longest-serving health secretary in history” — something, of course, he achieved in due course.
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