Will new health secretary Steve Barclay get the chance to leave his mark?
BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o1687 (Published 07 July 2022) Cite this as: BMJ 2022;378:o1687
It’s never easy being the “new boy.” Walking into new territory, all eyes on you, scrutinising your every move and word. It helps to build credibility fast.
But as Steve Barclay was appointed as England’s new health and social care secretary on 6 July, that task had just got a whole lot tougher.
The government was in freefall, reeling from high profile cabinet resignations—his predecessor as health secretary, Sajid Javid, being among the most high profile. Barclay’s boss, the now (seemingly) outgoing Boris Johnson, appointed him to the new role but was being written off as prime minister by most of the national press. As Tory MP resignations mounted (the toll stood at almost 60 by the time Johnson eventually fell on his sword), Barclay may have been wondering if he would even still have his new job by the end of the week.
The job insecurity was not lost on his new adversary Wes Streeting, shadow health and social care secretary, who was quick to tweet, “Congratulations to Steve Barclay on becoming the shortest serving health secretary in history.”
Time will tell how long Barclay is in post for. In the interim, the question for the NHS is: what will he bring if he does survive long enough to achieve anything meaningful?
NHS leaders’ “worst nightmare”?
According to insiders, Barclay didn’t win many friends during the 11 months he was a junior health minister between January and November 2018. He was responsible for NHS workforce, finance, efficiency but, interestingly, had little to do with the BMA in this time, despite workforce being a consistent policy priority.
According to sources quoted in the Health Service Journal, officials dreaded the idea of Barclay ever becoming health secretary because of his attitude and their clashes with him, mostly over health spending. In a damning editorial this week headlined “Steve Barclay is NHS leadership’s worst nightmare” the HSJ’s editor, Alastair McLellan, quotes insiders’ views.1
“A real nightmare, vindictive, arrogant, a bully, hostile to the NHS and all its works, a micro manager of the wrong things, views NHS management as bloated and profligate,” was one of them.
“Never has a politician arrived in the post . . . trailing a worse reputation among NHS leaders than Steve Barclay,” commented McLellan. “His ‘hard edged’ style rubbed people up the wrong way.”
“All the bombast and unfounded assumption of expertise of Hancock but without being a nice bloke,” was how one NHS leader summed him up.
Not the best start, perhaps.
“Tough” interrogator
Born to a trade union official father and a civil servant mother, the privately educated Barclay has previously described himself as coming from a “working class Northern background.”2 The first in his family to go to university (Cambridge), he went on to train as a lawyer and moved into politics only in 2010, after a successful career in the financial sector (regulatory roles at the Financial Services Authority and at Barclays Retail Bank).
This background made him particularly suitable to serving— and impressing— on the House of Commons Public Accounts Committee early on in his political career, during the coalition years. Here he proved a tough and effective interrogator of officials, taking on former NHS chief executive David Nicholson over severance payouts to NHS staff, for example.3
Barclay’s political career progressed quickly from his junior health minister role. He went on to become Brexit secretary in November 2018 under Theresa May, and this was followed, in February 2020, by an 18 month stint as chief secretary of the Treasury, where he was responsible for controlling government spending and public sector pay and pensions.4
Hawkish on spending
Political commentators have described him as hawkish when it comes to spending public money, particularly on health. At the Treasury, he is said to have pushed back on signing off the cheque for the covid vaccine programme on the basis of “value for money.” This left the NHS with no choice but to press ahead anyway, and by the time official approval had been gained, close to a million people had been vaccinated.5
He was also criticised over his refusal to apologise for the mistakes the government made in its handling of the pandemic.67
Barclays’s voting record shows he is a resolute loyalist—consistently voting with the government since becoming an MP. He has voted in support of government reforms to the NHS and against restricting the amount of income that trusts can earn from private patient care. On a crucial vote to improve workforce planning in the NHS (amendment 29 to the Health and Social Care Bill) he did not vote.
On health matters, he has voted against allowing terminally ill people to be given assistance to end their life and almost always backed smoking bans.
Can the “fixer” fix health?
Barclay has a reputation as someone strong on detail, a safe pair of hands, a fixer. Perhaps a gap year spent in the army at Sandhurst has injected him with a sense of getting the job done.
This explains why Johnson called him in to instil some discipline into Downing Street in February when he became his chief of staff. “When the going gets tough, UK prime ministers send for Steve Barclay” is how the politics site Politico put it.8
But just how good a fixer can he be? Downing Street built a special brand of chaos in those five months.
His fix-it skills will now face their toughest test yet. There is certainly no shortage of outstanding problems waiting to be fixed in his new department.
The BMA’s recently elected new chair of council, Philip Banfield, said Barclay’s most immediate priority should be working with the Treasury to secure proper funding of the health service, social care, and public health services. This will mean investing in recruiting and retaining staff and giving doctors a pay rise, unless he wants to invite a battle with the profession.
“If the government chooses another sub-inflationary outcome with no plan to address the long term decline in doctors’ pay, it will set them on a collision course with the profession,” Banfield warned.
Richard Murray, chief executive of the health think tank the King’s Fund, urged Barclay to make the workforce his priority. Barclay’s success will rest on his ability—or willingness—to convince a sceptical Treasury that a serious workforce plan is better value for money than the current drift into a deeper crisis, Murray said.
Barclay has much work to do and, if he had previous misconceptions about the NHS workforce and its leadership being inflexible or inefficient, he surely has no time to waste on underestimating the talents of the sector now. All eyes are on Barclay, for as long as he lasts in post.
The BMJ asked Barclay and the Department of Health and Social Care for a response but had not received one by the time of publication.