Being Health Secretary is an odd position for a Conservative MP. The right’s worst-kept secret is our collective acceptance that the NHS is fundamentally unworkable and should be replaced. Saying so openly would be political suicide. Yet any Tory who is not in agreement is likely naive, delusional, or a lobbyist. None of these are necessarily disqualifications for being an MP. But they are poor looks for a Secretary of State.
None of these words apply to Victoria Atkins. By all accounts, she is popular with her colleagues and an effective junior minister. Our new Health Secretary has long been tipped for promotion. Her father was a Conservative MP and MEP, and her mother a Tory councillor and mayor. Since being first elected in 2015, she has served in a variety of ministerial roles, the most recent being Financial Secretary to the Treasury.
As one of the few rising stars on the party’s centre-left, Atkins is hardly likely to be an ideological enthusiast for any newfangled market-based solution for the health service’s ills. Even if she was, she has precious little time and even less political bandwidth to use up on yet another top-down reorganization. Her mission from Rishi Sunak will have been simple: keep the NHS quiet until the next election.
The NHS continually places on the podium of voters’ priorities. If ministers find themselves in yet another dispute with junior doctors’ in the run-up to the next autumn, there are no prizes for guessing on which side they presume the public will come down. Even then, figures last week suggested the waiting list has reached 7.8 million. Another record high, this is exactly the opposite of Sunak’s pledge in January.
Indeed, it is highly unlikely that Atkins is going to be able to present the voters with what one might call a record of achievement come the next election. Total health spending is up £20 billion on pre-pandemic figures. The NHS employes 16 per cent more doctors than it did four years ago, and 15 per cent more nurses. Yet productivity has collapsed, falling by 25 per cent in England in 2020-21.
The NHS is suffering from long Covid. It carried out 9 per cent fewer admissions, 5 per cent fewer outpatient appointments, and 11 per cent fewer elective and maternity admissions in March 2023 than in the same month four years before. 8 million fewer treatments from the waiting list were performed during the pandemic’s first two years than predicted before it.
Improving this dire situation was an obvious priority of Steve Barclay, the predecessor of Atkins. The new Environment Secretary was a great enthusiast for deploying AI in the health service and aimed to use the Mahor Conditions Strategy to link up the treatment of particular egregious conditions. But his work was undermined by the seven junior doctors’ strikes he oversaw, including one with consultants.
The service judges the costs of these strikes as being around £1 billion. The Treasury is unwilling to make more funding, especially as the Chancellor is asking for another 0.5 per cent in annual efficiencies to free up some room for tax cuts next year. Having come from the Treasury, Atkins will be sympathetic to those aims. Yet the British Medical Association want her to pay up. Mandy Rice-Davies rules apply.
This is all before our most egregious of national festive traditions: our annual NHS winter crisis. More appalling than watching a live birth on Call the Midwife before you’ve even finished your sprouts, Atkins can look forward to the usual combination of weather, disease, and staffing intransigence to make the festive period both a misery for her and patients. It won’t do those Waiting Lists much good.
Fortunately, Atkins will at least be able to call upon some experienced heads to assist her in her new department. Maria Caulfield has both served as an NHS nurse and has been a minister in the department in various roles since 2021. But Atkins is also joined by Andrea Leadsom, erstwhile ex-Business Secretary, face of Vote Leave, and two-time leadership candidate.
Seeing a former Cabinet minister rejoin the Government as a lowly Parliamentary Under-Secretary of State is an unusual move, to say the least. But Leadsom will reportedly be focusing on the Best Start in Life, a long-standing passion of hers that will be familiar to ConservativeHome readers. Atkins will be hoping she can help give her the best possible start in her new department.
For all her enthusiasm, however, one suspects that will be an unlikely outcome for Atkins. Winter looms as the position of the NHS continues to deteriorate, however much money is shoveled into its gaping maw. That is before Atkins reconciles her interesting positions as both the guardian of the nation’s obesity strategy and the wife of the managing director of British Sugar. Echoes abound of Therese Coffey’s partiality for cigars.
Nonetheless, all ConservativeHome readers should wish Atkins the best, and not only because they might find themselves in the tender embrace of A&E this Christmas after an unfortunate accident whilst carving the turkey. Christmas is a time for miracles. If Sunak wins the next election, NHS reform is reportedly one of the dragons he wishes to use a full term to slay.
Atkins would need the experience to see that through. Seeing out the next year in her department will help her gain that, placing her in a swell position to lead the right when it once again swaps squabbling over personalities for the more tedious work of reforming public services, cutting government spending, and reducing the demand for government.