Incisive Health analysis of the re-appointment of Matt Hancock as Secretary of State for Health and Social Care in Boris Johnson’s cabinet reshuffle 

This is probably not what Matt Hancock would have wanted. As a leading and vocal champion of Boris Johnson who had previously fought what was widely considered to be an effective leadership campaign of his own, it was no secret that Hancock’s ambitions lay elsewhere. Yet, in a reshuffle where virtually nothing stayed the same, Health is one of the few areas of continuity.

Will Matt Hancock be disappointed? Probably, although not half as disappointed as many of the people he sat round the Cabinet table with earlier in the week. However, Health is still a major job and – just as he did when first appointed by Theresa May – we can expect him to approach the task with optimism and vigour.

He will also have some cover to try and make progress with social care reforms. For a politician who paints in primary colours, it comes as little surprise that Boris Johnson has been attracted to the idea that no one should have to sell their own home to pay for care. However, as Theresa May could tell him to her cost, delivering this in practice is somewhat more difficult than saying the words, and persuading the public to pay for it is unlikely to be popular. Matt Hancock’s task is now to translate the headline into a workable policy, winning arguments across Whitehall and with the public. This will be no easy task in the febrile pre-Brexit and pre-election atmosphere. There is still a risk that “immediate action” may well lapse into long term aspiration.

Beyond this, however, Hancock has limited room for manoeuvre. The excitement of the announcement of the NHS Long Term Plan, as well as the unveiling of personal priorities which is the prerogative of any new arrival as Secretary of State, has passed. Now comes the hard slog of delivery.

As the Government redoubles (or restarts) efforts to prepare for a no-deal Brexit, this will be the top priority. Should no-deal planning in the NHS go wrong, there will be no excuses for a returning Secretary of State. Health has won plaudits from across Whitehall for its no-deal preparedness. Matt Hancock will need to ensure this continues.

Also, an election is imminent. Even if Boris Johnson manages to deliver Brexit, a parliamentary majority that has all but disappeared will likely necessitate an election sooner rather than later. If Brexit stalls (again) or efforts to leave without a deal are frustrated, we can expect the new Prime Minister to go to the polls much sooner. For the Conservatives, this will mean keeping the NHS quiet as a political issue, avoiding controversy and seeking to focus debate on issues which are perceived as Tory strengths.

Part of keeping the NHS quiet will be ‘scraping some barnacles from the boat.’ For Matt Hancock, this will mean addressing issues which were not gripped before the leadership contest, as well as implementing the (limited) commitments the new Prime Minister made during the campaign.

We can expect to see measures to address the problems with doctors’ pensions which are now impacting on waiting times, action on access to general practice (although identifying ‘three weeks’ as the critical threshold leaves some room for manoeuvre), and action on capital investment for buildings and equipment. With the Government now led by prominent Vote Leave figures and Number 10 increasingly staffed by aides who were central to the infamous “£350m on the NHS” slogan, the immediate announcement on the steps of Downing Street of 20 ‘hospital upgrades’ should not be a surprise – although cynics might suggest the 20 have been scraped from the list of capital projects that were going to be funded anyway.

Then there is prevention. The Green Paper debacle has undoubtedly damaged relations with the public health lobby. The exact motivations for essentially disavowing his own policy are disputed, but what is clear is that the episode will make the returning Secretary of State’s job all the more challenging. Prevention was one of Matt Hancock’s priorities and, to make any progress on the issue, he will need to tread a fine line between Number 10’s instinctive opposition to intervention and the beliefs of the health community, including large parts of the Department of Health and Social Care and the leader of NHS England. This issue has the potential for some rhetorical milkshakes to fly, irrespective of whether they are subject to a sugar tax.

Does all this mean that Matt Hancock is now a lame duck Secretary of State? Far from it. There are some big arguments on workforce and capital that still need to be won across Whitehall and his position as an outrider for the new Prime Minister cannot be unhelpful. He also now has more time to indulge his passion for all things digital.

Always a very political minister, Matt Hancock will know that his role will be critical to the new Prime Minister’s electoral appeal, which may well be tested sooner rather than later. Make no mistake, he has a very big job ahead of him. It just may not have been the job he expected.