Hancock’s half month

In the fortnight since he took over from Jeremy Hunt as health and social care secretary, Matt Hancock has given one major speech and made his first appearance in front of the Commons’ health committee. Lyn Whitfield asks what we’ve learned about his agenda for the NHS – and its technology.

The career path taken by Matt Hancock, the new health and social care secretary, has some striking similarities with that of his predecessor, Jeremy Hunt.

Ten years apart, both men studied politics, philosophy and economics at Oxford and then worked for technology companies; the family software business in Hancock’s case and Hotcourses in Hunt’s.

Both found safe, county seats, in West Suffolk and South West Surrey, progressed their Parliamentary careers as advisors to former chancellor George Osborne, and passed through the department for digital, culture, media and sport on their way to health.

Building a reputation on digital transformation

In their early careers, both men also flirted with free-market solutions to public sector problems. Newspapers have noted that Hancock has received donations from the chair of the Institute for Economic Affairs, which wants to scrap the NHS and replace it with an insurance-based system.

However, Hunt – who once co-authored a book calling for the ‘denationalisation’ of the NHS – became a firm believer in a single payer model. And there’s little evidence that Hancock is particularly ideological.

A much-circulated profile on conservativehome.com says he is known for being “exceptionally ambitious” but struggles to identify anything that he stands for. The same profile notes that if Hancock is interested in anything, it is “digital transformation”.

In his first job at the DCMS, Hancock committed the government to rolling out superfast broadband. And earlier this year he famously became the first MP to launch his own smartphone app to update and communicate with constituents.

Big Brother Watch described the app as a “fascinating comedy of errors” after it was discovered that it collected a lot of personal information about its users. But Hancock should understand the complexities of health’s consent and information sharing debates.

As culture secretary he piloted the legislation that incorporates the EU’s general data protection regulation into UK law through Parliament. He also spoke out about some of the pernicious effects of social media on children and young people; a concern that will give him some common ground with NHS England chief executive, Simon Stevens.

Three priorities include technology

In his first speech as health and social care secretary, Hancock didn’t mention mental health, or safety; which arguably became Hunt’s great theme. Instead, he started by addressing two of his potential weak-points.

First, he not only declared “I love the NHS” but went on to describe it as “one of our nation’s greatest achievements” and one of the things that has “helped to make Britain great for the last 70 years.” Second, he expressed admiration and support for NHS staff; arguably Hunt’s Achilles heel after his battles with junior doctors and nurses.

Indeed, in a tweet ahead of the speech, Hancock identified ‘workforce’ was one of his three “early priorities”, alongside ‘technology’ and ‘prevention’ – narrowly defined as “keeping people out of hospital” and “empowering” self-care.

Playing up to his billing as a minister interested in digital transformation, Hancock revealed that he uses the GP at Hand service that uses Babylon’s triage, booking, and e-consultation technology. The service, which is provided by a London NHS practice, has been accused of “cherry picking” patients and taking money away from the traditional GPs left with the more difficult cases.

However, Hancock said the app “works brilliantly for me” and suggested that if payment rules don’t support this kind of innovation, it is the rules that should change.

Showing the money

Hancock also announced a “half-a-billion-pound package to help us jump-start the rollout of innovative technology” in the health service. Or, strictly, he re-announced money that Hunt had already announced earlier in the year, including £75 million for e-prescribing.

Hancock argued that the latter would “give clinicians more time to spend with patients and reduce potentially deadly medication errors by up to 50%”. But commenters on health tech websites noted that the money is a fraction of the cash that was promised by the two tech funds that were launched by Hunt to support his “paperless” ambitions for the NHS.

The roll-out of e-prescribing effectively stalled when the second tech fund was cancelled by the Treasury to fund winter-pressures; and it’s not clear that £75 million will be enough to roll-out systems to the two-thirds of hospitals that still lack them.

All about interoperable data architecture

In advance of his speech, Hancock engaged in an interesting exchange on Twitter with someone who criticised his focus on tech “if it means we will, again, be pumping £billions into bullsh*t IT systems and mediocre ‘tier 1’ suppliers who produce some[thing] half-baked, late, over-budget & not fit for purpose.”

Hancock said this would not happen. “No chance. It’s all about interoperable data architecture,” he wrote; suggesting that, for the moment at least, he will be backing the direction set by Hunt and NHS England since the Wachter review in 2016.

In hospitals, this means the global digital exemplar programme to develop ‘world class IT’ and then spread it via ‘fast followers’ and ‘blueprinting’, plus the more recent emphasis from Matthew Swindells, director of commissioning and operations, on ‘open’ platforms on which suppliers can ‘plug and play’.

Outside hospitals, it means local health and care record exemplars to integrate systems across healthcare communities, and NHS Digital’s ‘target architecture’ for collecting data and analysing it in regional innovation hubs of 3-5 million people.

Indeed, in his speech Hancock said: “Interoperable data standards over clinical and operational tools and world class, secure use of data are the bases on which modern technology and modern research must rest.” And he had a less than coded warning for suppliers that failed to get with the programme.

“We will work with suppliers who want to embrace this change,” he said in an order reported line. “I am crystal clear that suppliers who drag their feet or threaten to stand in the way will not be suppliers for long.”

The big ticket items

The big agenda items on Hancock’s new desk are securing the ‘birthday present’ of an additional £20 billion for the NHS by 2023 that was announced by Theresa May for NHS70 at the start of July, drawing up a ten-year plan to spend the money, and sorting out social care – for which a green paper is promised this autumn.

Questions on these topics were the focus of his first appearance in front of the Commons’ health and social care committee on the Tuesday that Parliament broke up for its summer break.

The £20 billion only covers NHS spending in England – and not other elements of health spending, such as public health or training – and think-tanks have warned that it will only be enough to ‘sustain’ – rather than transform – current services.

Against this background, former GP and committee chair Sarah Wollaston asked Hancock how he was going to fund his priorities. Hancock said he hoped the Treasury would find non-NHS health and social care funding in this autumn’s spending review; but he also suggested there is money in the system.

Reform agenda underpinned by IT

The 2014 Five Year Forward View put a lot of emphasis on integrating health and social care, to reduce friction, keep people out of hospital, and support care at home. Stevens has said the ten-year plan will update rather than ditch this approach.

Asked whether he would go further, by transferring social care to health or restructuring services, Hancock said he might consider it, but there are problems with “large, top-down reorganisations” and other ways to achieve the same goals.

Specifically, he suggested that many challenges could be solved by using technology “to better integrate teams, even if their funding is coming from different places.”

A renewed focus on integrated care would put a premium on the kind of information sharing projects that are being taken forward by the LHCREs and some STPs; and the Health Service Journal reported that the bulk of the money that Hancock announced or re-announced in his first speech will be spent at an STP level.

Some cash will also go on consumer technology. In his speech, Hancock flagged work with Amazon to make NHS Choices information available via Alexa, so “expert information prepared by the NHS” is available via speech rather than keyboard.

Good news for health tech companies

Hancock may have a Treasury and free-market background, but he does not seem to have arrived at health and social care with a grand plan to change the NHS.

If anything, he has gone out of his way to show his commitment to the service (he turned up at the health and social care committee wearing an NHS lapel pin even larger than the one that Hunt used to wear, complete with a new ‘pride’ rainbow).

And for the moment, at least, he is talking the same language of reform as his predecessor and NHS England’s chief executive. Having built a career on digital transformation, he has endorsed current policy on interoperability and data collection, while stressing the importance of technology to that reform agenda.

All this must be good news for tech companies that want to work with the NHS; and Hancock has been able to confirm that there is some money available.

Headlines and time against him

On the other hand, Hancock has only been in post for two weeks. Policy direction could change as he gets into funding debates with the Treasury and ten-year plan debates with NHS England. Even if it doesn’t, the money that he identified for health tech in his first speech is not new and will not go far.

And there are distractions ahead. Conservativehome.com noted that Hancock has tended to make the most out of the ministerial positions he has held, by picking a high-profile issue and running with it.

Campaigning on the mental health impact of social media, or issuing releases about patient-facing tech, are more likely to fit with this agenda than pushing on with the hard slog of digitising hospitals or building standards based care records.

In addition, Hancock arrived at health and social care because of Brexit: and that’s not an issue that is going away any time soon. Even in his committee meeting he was forced to confirm that his department is looking to fly in medicines and medical isotopes in the event of a hard Brexit.

A change of prime minister, general election, or crash out of the EU could all see him depart again. Hunt became the longest serving health secretary shortly before he left for the Foreign Office. In that, at least, Hancock is very unlikely to follow the older politician.

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