Steve Barclay’s legacy as health secretary

Abrasive

Few in the NHS will miss him. He was a junior health minister for most of 2018 and was then promoted to chief secretary to the Treasury from February 2020 to November 2021—the main period of the pandemic.

As Treasury secretary, Barclay seemed to delight in behaving abrasively towards NHS leaders. The Spectator revealed that as well as seeking to micro-manage individual hospitals, Barclay oversaw the refusal to approve funding for the covid-19 vaccination roll out on the grounds that it did not provide value for money.3 Simon Stevens, then chief executive of NHS England, went ahead regardless, and Treasury approval was retrospective.

No extra billion pounds for the “bottomless pit”

In a piquant irony, Barclay spent his last few weeks as health secretary lobbying HM Treasury for an extra billion pounds in funding for this “bottomless pit,” (as he referred to the NHS) in part to cover the additional costs caused by the medical workforce strikes (of which more below).4

He was unsuccessful: only about £200 million of genuinely new money was forthcoming.5

As a result of the Treasury’s refusal, NHS England recently issued an edict that NHS trusts are now to pursue financial balance at the expense of trying to reduce waiting lists.5 Capital budgets are also going to be raided, and local leaders will be permitted to cut spending on cancer, prevention, learning disabilities, and autism services.6

The latest data reveal that the English NHS’s finances are in a mess: over three quarters of a billion pounds over budget at the end of the first quarter of this financial year.7

Waits and measures

Prime minister Rishi Sunak made cutting NHS waiting lists one of his “five pledges” for 2023. NHS England’s referral to treatment (RTT) backlog was 6.5 million when Barclay first became health secretary: the latest data show it has risen to 7.8 million.

The government missed its elective recovery plan targets to eliminate two year and 18 month waits by July 2022 and April 2023 respectively.5 They sought to re-brand the targets as “covid recovery,” despite the RTT backlog being 4.4 million strong already in 2020. Nor does the government look on course to eliminate waits of longer than a year for elective care by March 2025.

There were also unmet targets for three quarters of patients who have been urgently referred to a specialist by their GP for suspected cancer; and for patients to have cancer ruled out within 28 days; and to return the number of people waiting more than 62 days from an urgent referral back to pre-pandemic levels by March 2023.

As for the ambition to “deliver around 30% more elective activity by 2024/25 than before the pandemic,” there is no credible plan to achieve this. This is a figure which belongs in the same realm of fantasy as the government’s plans for 40 new hospitals by 2030 (of which there will not be 40, and they will not be new hospitals).8

Strikes

If most people were trying to fix a massive backlog in the NHS, they probably wouldn’t choose a fight with its medical workforce over pay.

Barclay repeatedly told the BMA junior doctors’ committee that they must move away from their 35% “full pay restoration” claim, walking out of talks when they did not guarantee this. Sunak also endorsed this approach, claiming in July that “there will be no more talks on pay.”9,10

Speculation that the BMA’s consultants would “never vote to strike” turned out to be far wide of the mark, with June’s vote finding 86% voted to strike on a 71% turnout.11 This led to a week of industrial action including an historic joint strike of “Christmas Day only cover” in September 2023, during the Conservative Party conference in Manchester.12

Although pay talks are now underway, Barclay’s rhetoric of promising to “take on militant doctors” unquestionably deepened and prolonged this dispute.13

Care access and quality deteriorating

Recent reports from the National Audit Office, the Care Quality Commission, and NHS Providers point to decreased access to and quality of NHS care.141516 The OECD’s latest “Health At A Glance” reinforces these points.17

These reports also show a lack of confidence among the workforce about how the NHS will cope this winter.

The worst winter until this one

The winter of 2022-23 was a truly terrible one for access to and quality of healthcare in much of the country, as data from NHS Providers show.18

While there have been some extra resources, and an unevaluated programme of virtual wards (with uncertain numbers as regards supervision) has been rolled out, the NHS is going into the current winter in “cuts” mode, and few people are confident that the oncoming winter will not be as bad as the last: it could even be worse.19