• Mr Hancock said he did not want to spend Mondays deep diving into individual trusts
  • He criticised the NHS fetish for piloting everything rather than rolling out improvements in waves
  • Elective activity will be held back at winter and brought forward if pressure is better than expected

Health secretary Matt Hancock has signalled the government will launch a further crackdown on the use of agency staff.

Speaking via video link at the NHS Providers Conference in Manchester, Mr Hancock criticised the continuing use of agency staff as not cost effective and contributing to the demoralisation of substantive staff.

The health and social care secretary also set out how he sees his role as an “executive chairman of the whole system” and in a pointed reference to former health secretary Jeremy Hunt, Mr Hancock said he had no intention of spending Mondays delving into the details of individual trusts.

On agency staff, he said he was “frustrated” at the level of vacancies carried by the NHS and covered by agency staff adding: “We’ve also got to remember, as leaders of people, that agency hits morale because if you’re working at three o’clock in the morning on a nurse station and the person next to you is in the hospital for their first time and they find it very hard to do as good a job, you’ve been there for years, and they’re being paid several times more than you for the same shift, and they don’t have the responsibilities and can walk out the door if it all gets a bit much, then that is demoralising.

“There has already been downward pressure on agency use in the last couple of years but boy there’s going to be a whole lot more.”

He said some trusts had no agency usage but others were using agency staff when the bank was available which was “hard to justify.”

NHS Improvement has brought in a cap for agency nurses and doctors but it is regularly breached by hospitals who need to source staff at times of shortages to maintain safety.

Asked to define how he wanted to approach the role of secretary of state, he said: “I am by instinct an iterative reformer. I see the role as to set a direction, fight the battles for the NHS across Whitehall and to communicate where we are going and handle crises as and when they occur.

“Occasionally I will have to dive deep into the details of one particular area like clinical waste or the finances of one individual trust but that’s pretty rare. I don’t plan to spend every Monday diving into the details of one trust or another, if I need to dive into the details of a trust, that trust is in need of some very serious attention.

He said Ian Dalton’s role was to make sure NHS trusts were “on the straight and narrow” while Simon Stevens was there to provide “the day to day leadership of the system.”

“My role is more like an executive chairman of the system as a whole”, he said.

On winter, Mr Hancock said he wanted to take a different approach on balancing elective and non-elective activity saying: “I want to plan in advance to ensure that there’s capacity for the inevitable spike in activity and then if it isn’t as bad as last year, if the flu is less acute, then we can bring forward electives rather than putting it off.”

On the long term plan and existing cost pressures for NHS trusts, Mr Hancock said: “I’m determined to ensure that the extra money doesn’t get frittered away in the way that lots of people thought it was in the mid-2000s.”

He criticised what he called the NHS’s “fetish” for piloting everything saying: “One of the big problems I’ve been really surprised about on arrival in the NHS is how many things are piloted and how infrequently even successful pilots get taken up. The promulgation of good ideas is really poor and needs to improve and part of the reason for that is a fetish about piloting everything as opposed to learning from successful pilots or from good wave one projects, iterating them, changing them where necessary and then getting that rolled out.”

On wider workforce issues, Mr Hancock said he wanted to “see a change in the levels of morale in the workforce of the NHS which could be and should be one of the very best places to work in the world.

“We rest on our laurels and we use the fact it’s such a mission-driven job, that people really love, not to give people the best management and ultimately leadership that they deserve.

“The result of that is relatively high levels of bullying and we are seeing increases in difficulties in retention. I think there is a huge amount of attention everyone needs to pay to ensure we have a highly motivated, highly valued workforce and what that takes is leadership.”

He cited variance between NHS trusts as a major concern for him, adding he was “frankly astonished and the different ways of doing the same thing as opposed to following best practice.”