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Some of Sajid Javid’s friends wanted him to return to the Government as Education Secretary.  This might have suited the meritocratic campaigner, whose leadership election pitch was: “I’m in this race because I want to level the playing field, to lower the ladder to everyone”.  And who also has a big interest in skills.

Others believed that he could come back as Foreign Secretary, thus completing an all-Asian line-up in the three great offices of state: Rishi Sunak at the Treasury, Priti Patel at the Home Office…and Javid.  It is just the sort of “eye-catching initiative” that might have found favour in Downing Street.

We wondered if a lower key, lower drama return might come at Work and Pensions, where Javid’s numeracy and Treasury experience would come in useful.  At any rate, there was no shortage of options for slotting The Saj back in – always likely, given the departure of Dominic Cummings, who doesn’t rate him, and the presence of Carrie Symonds, his former Special Adviser.

What neither he nor Boris Johnson may have anticipated was a recall to Health – a move necessitated by Matt Hancock’s defenestration, and the Prime Minister’s determination to keep Cabinet changes to a minimum.

Javid is becoming the John Reid of the Conservative Party, having now served at Cabinet level in the Treasury, the Home Office, the Business Department, Housing and Culture: the man one calls upon to fill a gap or fix a problem.

However, nothing will have prepared him for what he is about to experience.  The CCTV camera that doomed Matt Hancock has apparently been dismantled.  But never mind secret tape in the office – never likely to be a problem, in any event, for this most uxorious of politicians.  Rather, the new Health Secretary should be greeted by a three-word warning sign: “Welcome to Hell”.

Consider the challenges that confront him.

Housing produced the Grenfell horror; the Home Office, Shamima Begum; Business, Tata Steel.  All were one-offs – the equivalent of a jab with a sharpened stick.  The health job, by contrast, brings with it persistent pressure: like being squeezed tight by the coils of a giant python.

First of all, Javid has to establish a position on Covid.  His early hope that restrictions will be lifted “as soon and as quickly as possible” seems immediately to have been gutted by his department.

The odds are that the remaining elements of lockdown will end on July 19, only for pressure for shutdown to return in the autumn as Coronavirus and flu cases climb.  The new Health Secretary’s first task will be to get to grips with the issues.

But it’s after Covid that his problems really begin.  Whether or not Boris Johnson makes an early dash to the polls in the autumn of 2023, health is likely to dominate headlines in 2022, with over five million people waiting for treatment.  Labour won’t be able to help themselves trying to frame the next election as “a referendum on the NHS”.

Javid will find himself on the Today progamme, in the Commons, on the airwaves and in front of Andrew Marr on a regular rather than an occasional basis.  Even in his varied career, he won’t have experienced anything like it.  But making the case for the Conservative record on the NHS will be only the start of the new Health Secretary’s labours.

Read Robert Ede and Sean Philips’ recent piece on this site. (“The Government faces an election run-up monopolised by reports of NHS waiting times and delays”).  As if grappling with the Covid backlog were not enough, Javid faces no fewer than four other major policy challenges, at least three of which require legislation.

First, there is the plan to split up Public Health England into two new bodies – the UK Health Security Agency and the Office for Health Promotion.

Next, there is reform of the Mental Health Act, which will require a draft bill.

Penultimately, there is the NHS and Care Bill, due in this session, which “will provide the framework for a more integrated and joined-up healthcare system in England”.

And finally, there are the Government’s proposals for social care, whenever they emerge.

The third has the potential to rock Javid’s boat and the fourth to wreck it.  Competition and co-operation are the two main drivers of healthcare policy.  And there has been an apostolic succession of competition-based policy from Ken Clarke’s GP fundholding, through Alan Milburn’s partnership with private health care to create new capacity, to Andrew Lansley’s batttered reforms.

The right-wing think tanks will kick back against any attempt to water down competition, and there may be rumbling on the Conservative backbenches.  But if most Tory MPs are onside, as they can reasonably be expected to be, Javid can take opposition on the chin.

Social care is a horse of a different colour.  In opposition, Cameron’s Conservatives wrecked Labour’s potential reforms by labelling them a “death tax”.  In Government, Theresa May’s unprepared, unfloated policy did more than any other to lose her seats in 2017.

On the downside, Javid has no background in a health-related departments.  His recent areas of interests have included the economy after Covid, drawing on his Treasury experience; reducing child sexual abuse; raising the minimum marriage age to 18, and rough sleeping (see his ConservativeHome piece).

The last two campaigns were closely related to his experience at Housing, Communities and Local Government, and its to his credit that he kept going on both.

On the upside, the new Health Secretary knows his way round the Treasury – he is the first to be a former Chancellor, rather than the other way round – which will be invaluable during this testing period ahead.  And since Ministers are necessarily generalists, he is no more disadvantaged taking up the post than any other first-timer.

Javid is about to find himself the most publicised Health Secretary since Lansley.  He will hope that his tenure at health doesn’t end the same way.