Sajid Javid was once described as “more Thatcherite than Thatcher”. His Ministerial office is adorned by a picture of the Iron Lady. At his 2019 leadership campaign launch, he said that he “got on his bike” to go to a better school – echoing the famous phrase of Norman Tebbit, one of her key lieutenants.
Margaret Thatcher is still a defining political figure because her agenda was so clear and her convictions so strong. She drove through her economic reforms – in favour of productivity, challenging inefficiency – against the opposition of the Establishment. As voters of the time would say, they might not have liked Maggie, but they knew what she stood for.
Mr Javid has the hardest job of any politician. The Opposition sees the Health Service as its territory and ceaselessly repeat the unfounded charge that Conservatives don’t believe in the NHS. On top of that, the Health Secretary has inherited the biggest public health challenge for a century and the longest waiting lists for a decade.
Even making allowance for this, he will know that he has yet to find his voice. Appearing on the Andrew Marr Show last weekend, Mr Javid’s main point was how bad things are, with waiting lists rising and a manifesto commitment to recruit 6,000 extra GPs about to be failed. Surprisingly, he did not set out his solution to these problems, beyond making the general point that the NHS would have additional funds raised by the recent tax increase.
In previous speeches, he has made a commitment to “reform” the NHS, meaning improved digital technology and a review of NHS leadership under General Sir Gordon Messenger. The trouble is that reviews of this kind tend not to produce anything worthwhile. A predecessor, Jeremy Hunt, commissioned the same review – “Better leadership for tomorrow” – in 2014, from Sir Stuart Rose, the former chief executive of Marks and Spencer. Sir Stuart came to the very reasonable conclusion that the NHS was “drowning in bureaucracy” and needed the application of some “common-sense tactical and strategic thinking”.
Ministers were so fearful of causing controversy that they put the review on the backshelf. It was eventually published after the 2015 General Election when its value was entirely lost. General Sir Gordon Messenger’s review will likely meet the same fate.
The good news for Mr Javid is that his Thatcherite instincts are exactly what the NHS now needs. He wants to increase the capacity of the Service so that it can cope with rising demand. As an NHS manager recently told me, NHS capacity equals “work plus waste”. In her view, the task of health leaders is to drive out the waste so that more useful work is done, overall capacity rises, and more patients are treated.
His productivity agenda should include immediate practical changes, such as preparing reserve lists of patients so that operating theatre time is never lost if there is a cancellation. It should cover longer term reforms, including the creation of surgical hubs that treat five or six times the number of patients treated in a typical NHS hospital. The overall impact will be a more efficient Service that makes better use of its funds and attends to many more people as a result.
While productivity is a Thatcherite idea, it has been supported by Labour politicians, such as former Health Secretary Alan Milburn. It is also central to the 2019 NHS Long Term Plan which Mr Javid can champion.
Health Secretary, this is no time to exude pessimism. You can promote pragmatic ways to quickly raise the quality of health services. When you argue that the NHS should be efficient, you will find many supporters within the Service. Now is the time to have the courage of your Thatcherite convictions.
Andrew Haldenby is co-founder of Aiming for Health Success, a new health research body