The most difficult time for a new secretary of state is normally the first three months in the job. An early mistake can sink confidence among both the public and Whitehall officials. But for Sajid Javid, his first three months as health secretary will be his easiest. The real challenge will come later.
The easing of restrictions on 19 July will almost certainly go ahead, which means Javid will be able to point to an early success. I understand that the current plan, which the government will set out next week (though the formal decision on whether to proceed will only be taken a week beforehand), is for a comprehensive reopening. The one-metre rule will be ditched, masks will no longer be compulsory and venues will be allowed to operate at full capacity again. The aim is that all legal restrictions will be removed apart from the requirement to isolate for people who test positive for Covid. Test and Trace will continue to ping those who have been in contact with the infected, but for most people tests should be sufficient to allow them to continue their daily business.
Vaccine passports will exist for international travel. But domestically venues will not be legally compelled to check attendees’ Covid status. There will, however, be no new laws to stop them from doing so. I suspect some large venues will be keen to use immunity certification if they think there is a chance this will allow them to stay open later in the year. In a sign that domestic vaccine passports are not dead, one Whitehall source describes certification as ‘a tool that can be used come winter if we need it’.
When restrictions are eased, Javid will be lauded by Tory MPs for restoring liberties. Contrasts will be drawn with Matt Hancock. But the truth is that the 19 July reopening would almost certainly be going ahead even if the health secretary had not changed. Javid will also benefit from the fact that he can’t be held accountable for any mistakes made earlier in the pandemic. One long-serving figure observes that Javid is ‘coming in at just the right moment’.
The political challenge of the reopening will be that cases will still be rising as restrictions ease. The government will have to explain to the public why high infection numbers should not alarm them at a time when there will inevitably be scientists calling for restrictions to be reinstated. Their best response to this is that the vaccines have, at the very least, greatly weakened the link between cases and deaths. There will still be a rise in the numbers going into hospital with Covid, but it should be manageable.
This communication challenge pales in comparison to what is coming in the autumn and winter. At the end of this summer, the NHS will have a huge backlog of non-Covid care that has built up during the pandemic. Waiting lists are, for the first time ever, above five million. These will only grow as patients who were put off seeking medical help because of concerns about Covid — undoubtedly stoked by some of the government’s own advertising campaigns — come forward. There have also been restrictions on what kinds of medical services are on offer. Between March 2020 and March this year, there were around 90 million fewer face-to-face GP appointments than there had been in the previous 12 months.
The question is whether the NHS can handle this backlog once Covid cases flare up in the winter months, as more people socialise inside. Flu is expected to be especially bad this winter since the restrictions of the past 16 months have meant that people have less natural immunity than usual.
When hospitals were concerned about capacity during the 2018 winter crisis, Jeremy Hunt set a precedent by cancelling non-elective surgery. The problem is that similar cancellations now would make the backlog even bigger. As one Department of Health figure warns, you could get into ‘a spiral where you are never able to get a clear enough run to get out of it’.
Another problem is that the biggest drag on NHS productivity are the new infection-control regimes put in place to stop the spread of Covid. But if those restrictions were eased, it would risk letting the virus spread more in hospitals.
At the moment, the hope in Whitehall is that vaccines and less onerous forms of infection control can help solve these problems. Before Hancock resigned, the expectation in government was that the details of the autumn booster-shot programme would be set out by the end of July. Javid will now want to review this, which may delay the announcement. But it is probable that, at the very least, anyone over 50 or with an underlying health condition will be offered a booster shot. The aim is for people to get both a Covid booster and a flu shot in the same appointment, in the hope that this will increase take-up of the flu jab. In hospitals, the plan is that the use of specialist filtration FFP3 masks, which a Cambridge study found to be ‘most likely’ 100 per cent effective in preventing viral spread, can allow for other infection controls to be eased.
There will still undoubtedly be a call for more restrictions this winter. Patrick Vallance, the chief scientific adviser, has suggested that these will be relatively limited — face masks, for instance, rather than curbs on movement. Chris Whitty, the chief medical officer, is more downbeat. He warned recently that the NHS needs to ‘brace’ itself as there will be a ‘further winter surge’.
An efficient booster programme and proper PPE procurement would maximise Javid’s chances of keeping both the NHS and society open this winter. This would be a far more significant achievement than proceeding with the 19 July reopening.
Javid has run more government departments in seven years than Ken Clarke did in 23. He wasn’t around long enough in any of them to leave a lasting impression. At Health, he has the opportunity to change that. But he will have to get through this winter first.
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