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Former culture secretary has thoughts on NHS culture

After professing his unconditional love for the NHS, one of the new health and social care secretary’s first formal decisions taken under his watch was the announcement of a salary rise for doctors below the pay body’s recommendation.

Matt Hancock will swiftly realise, if he did not already know, that it will be his actions, not his rhetoric that health service leaders and frontline staff will judge him on.

That said, some of the rhetoric has been noteworthy. The former culture secretary took little time to establish his three priorities. No, not technology, technology and technology, but prevention, workforce, and, you’ve guessed it, technology.

And, his first appearance at the health and social care select committee this week provided a few more steers as to how the new broom is approaching the top job:

First, Mr Hancock confirmed that the government is planning to stockpile drugs for a no-deal Brexit and that he has “accelerated” the contingency planning process for which the costs could be significant.

Second, he set out in robust language his views on NHS’s management. He accused the health service of showing a lack of respect for staff and having “very, very old school management which make it far less pleasant than it should be to work in the NHS”. He did however indicate that he might be less interventionist than Mr Hunt was in pushing for the sacking of chief executives of struggling trusts, as happened ahead of last winter.

Third, he also confirmed that the proposed new NHS England chair, the name of which is understood to be awaiting clearance from the prime minister, will not begin before facing a Parliamentary pre-hearing appointment after the summer recess. Sir Malcolm Grant steps down from the role in October.

England’s least keen STP?

It’s not unknown for clinical commissioning groups and trusts to have a grumble about sustainability transformation partnerships behind the scenes but it is unusual for that negativity to spill over into any public arena.

Yet in Kent and Medway, three CCGs would not approve their STP contributions at the first attempt, citing a range of concerns around value for money, transparency and impact on the population. One – Ashford – backtracked at a subsequent meeting but two more – Swale, and Dartford, Gravesham and Swanley – will get the chance to do so today.

It’s likely that they will back down (the discussion will be in the private part 2 of the meeting so HSJ can’t be there to report it) but such widespread dissonance could make the STP think again about how it communicates with its constituent parts.

If so, arranging a discussion between the chief executive of the STP – Glenn Douglas – and his counterpart, the accountable officer of the eight CCGs – also Glenn Douglas – should be straightforward. Allaying CCGs’ fears that they put a lot into the STP and don’t get a lot out may be slightly harder.

(Worth noting is that not everyone was up for a single accountable officer – Thanet and South Kent Coast CCGs were reluctant to accept a single AO across the county – but eventually relented)

There’s also a little bit of east/west rivalry in some of the issues raised. The STP’s involvement in East Kent – which is heading for public consultation on a very controversial but overdue reconfiguration – may mean less focus on the north and west of the county and other much needed projects.