Since he first entered Cabinet back in 2014, Sajid Javid has held a dizzying array of top jobs. To date he has served as Culture Secretary, Business Secretary, Housing Secretary, Home Secretary, Chancellor and, latterly, Health Secretary.

Being a ‘Saj of all trades’ has its upsides – there are likely few senior ministers with greater breadth of experience in government.

But it also means that he has not really had the opportunity to really make his mark and build a legacy in any role. Indeed, his big speech on healthcare reform from last week even alludes to the fact that he never got to deliver a budget as Chancellor.

This probably helps to explain why Javid has grasped one of Westminster’s most poisonous chalices, NHS reform, with both hands. Speaking last week to the Royal College of Physicians, he spoke of:

“…the long-term challenges that healthcare must adapt to: changing demographics and disease; changing technology and expectations; and unsustainable finances.Taken together, it’s clear that we were always going to come to a crossroads: a point where we must choose between endlessly putting in more and more money, or reforming how we do healthcare.” 

Getting ahead of potential NHS trouble would also be smart politics, of course. Events in Ukraine may have driven ‘partygate’ from the front pages, but it hasn’t undone the damage to the Prime Minister’s standing with the electorate and in any event, British voters have a poor track record of voting on the basis of gratitude for past foreign policy success.

Yet at the same time, Javid’s options are relatively restricted. As he acknowledges in the speech, it could take a decade or longer before the benefits of major reforms work their way through a structure as sprawling as the Health Service. Moreover, even if the next election isn’t held until 2024, he isn’t going to have time to bring in any more major legislation.

Thus many of the things mentioned in the speech are in fact things the NHS is already doing – expanding the ‘Shared Lives’ care scheme, for instance, or continuing to roll out the personalised care agenda.

But whilst the aspirations are nothing to object to, for the most part, the political detail might be a bit trickier. Take the following goal: “Our current target is for 200,000 people to have a personal health budget by 2024, but I want to see a significant expansion in the coming years.”

To a lay listener, the word which probably leaps out most about ‘personal care budget’ is ‘budget’. A budget is, almost definitionally, finite. What if it runs out? The chief selling point of the NHS (it certainly isn’t outcomes) is the fact that people can draw indefinitely on its abstractly vast and thus comfortingly infinite-seeming resources.

Javid insists that such fears are groundless, and that personalisation works well. Perhaps its in order to quell them that he topped the speech with a big helping of the mandatory nostrums: pretending the NHS is a world-class health service; inviting comparisons only with the American alternative rather than European systems, and so on. He also engages in what is becoming a common bit of rightist sleight-of-hand by presenting preventative healthcare, which is often expansive and prohibitionist in character, as ‘small state’ because it brings NHS costs down.

This may simply be the price of doing business as a Conservative, even a libertarian-minded one, who needs to try and reconcile the fact that the Health Service is a ruinously expensive way of delivering middling care with the fact that the public are extremely attached to it, at a time when there’s no new money and when the 2019 manifesto didn’t really detail any reform (save for a headline commitment to “improve NHS performance” by spending more money).

Either way, he will have to pull off a delicate balancing act. As Robert Ede pointed out on this site back in January, waiting lists are exactly the sort of issue on which Labour would love to campaign at the next election. Giving patients on waiting lists the option to get treated at private hospitals sounds like a sensible proposal. But there is again the danger of it being misrepresented as parking private tanks on the NHS’s hallowed lawns.

Regardless, after years of bouncing from position to position one can’t fault the Health Secretary for being keen to make his mark on one of this country’s most important institutions. Whether anyone can actually put the NHS on a sustainable footing, given the growing gap between public expectations and available resources, remains to be seen.