The 3 key things I’d ask of any new Secretary of State for Health and Social Care

Since the Conservatives came into government in May, 2010 there have been 8 changes in Secretary of State for Health – and with a General Election rapidly approaching, there may well be another person in post before the end of the year, whether that’s by reshuffle or through a new Administration coming to power. That got me thinking – what would I say if I had 10 minutes with a new Secretary of State for Health and Social Care to help them be as effective as possible from day one?

Politicians seem to love three word slogans to get over key concepts to the public – “Hands. Face. Space.”; “Education. Education. Education.” spring instantly to mind. So maybe a similar approach would help get over my own message? With potentially a short time in post they will need a laser focus to effect any positive change. To my mind a new Secretary of State for Health and Social Care should concentrate on the 3 Ps – Patients. Professionals. Patience.


It seems odd that it needs to be stated that Patients should be front and centre for the NHS, whose reason to exist is the provision of public healthcare, but my experience has told me that it’s easy to become distracted by fresh initiatives, new technology panaceas and the short term buffeting of the political cycle and news agenda. Perhaps the most useful contribution a new Secretary of State can make is to keep an unapologetic and relentless focus on the needs of patients.

Repeating the mantra “what benefit will this deliver for patients?” at the start of every meeting; request for budget; and as new initiatives are proposed, would set an important tone that would cascade throughout the NHS, its employees and suppliers. Such a simple message would stop people from being distracted by shiny new technology for its own sake, pet projects, and elusive promises of cost savings and efficiencies. Such things are important but are not the end in themselves. Everything needs to be about what benefits will accrue for patients. The Secretary of State should always be challenging the NHS with “...and what is this going to do for patients?”


Our health and care sector professionals are the kindest, most selfless people in our society. They took the decision in their early lives to dedicate their careers to helping others. That’s a path unlikely to bring fame, fortune or an easy life, so how can we enhance their ability to deliver for their patients?

Direct benefits to patients often come from better enabling our clinicians. For example, in my own sphere, the application of technology must make the job of care professionals easier – while maintaining standards, safety and security. The overriding goals cannot be abstract ‘cost savings’ or ‘ digital transformation’ for their own sake, for example. There must be a concrete link as to how employees’ day-to-day jobs will be enhanced and their morale improved, and how this will flow through into better patient care.

I’d also make a special mention of IT professionals in the healthcare sector. There needs to be “parity of esteem” between different groups within the NHS. As a younger profession, IT sometimes does not command the same level of respect or share of voice that the likes of medical, nursing and finance professionals do because of their long history. Also with the ubiquity of home computing and use of mobile devices, voices from the long established professions can feel that they are ‘IT experts’ and so may exert undue influence beyond their main area of expertise. IT leaders need to be given the respect they deserve and the NHS must listen to their input, and develop them professionally through defined career paths.

IT professionals must also step up too. It’s often easy to get into the mindset that IT would run perfectly if it wasn’t for those pesky users! The IT team needs to keep asking “what is this technology going to do for patients?” and “how will this IT project improve the working lives of clinicians?”.

Investing emotionally and financially in the professionals needed to deliver digital success to the NHS should be a priority for the new Secretary of State.


The Health Secretary, and indeed the country, cannot expect instant solutions. Success is even less likely if there is constant chopping and changing of direction, focus and initiatives. Transformation takes time and in healthcare it can take even longer than in other industries. The NHS is a huge complex adaptive system and by definition change needs to develop, iterate and embed.

According to the Kings Fund NHS England employs around 1.4 million, making it the biggest public sector employer in the UK. According to the Nuffield Trust, it is one of the top ten largest employers in the world, sandwiched between the People’s Liberation Army in China, Walmart and Amazon, all of which have long term leadership and consistent plans and direction.

Understanding the concept of ‘Adaptive Change’ is important. Introducing new technologies and different ways of working into a large organisation can bring benefits from day one but to reach full potential the workforce must be able to absorb the changes, embed them into their working practices and learn how to creatively use the tools to deliver additional, often unexpected positive returns.

For example, in a hospital with thousands of staff and hundreds of existing IT systems, moving from keeping paper documents to fully digital record keeping might even lead to a dip in efficiency in the short term as staff get used to the change. There will be dozens of short cuts, time savers and workarounds which will have evolved under the old system. In time employees will creatively develop their own new ways of working to get the most from new technologies. Some of these will have been envisaged but many more may be innovations delivering unexpected additional benefits.

Final thoughts

After explaining the 3 Ps of Patients, Professionals and Patience to any new Secretary of State for Health and Social Care, I’d leave them with one last thought. The NHS would be overjoyed if government could prioritise consistency. Guaranteed budgets and goals for the next decade would give the best chance for value for money successful delivery. In healthcare many contracts and projects must be long term and so need financial certainty. Long term consistency rather than annual funding rounds would redirect the energy away from repeatedly making the case for budgets and projects and into their successful delivery.

Hold your nerve. Stick at it. Be willing to stand up in front of the public and say – yes, improvements can be delivered incrementally but big changes take time. For a lasting legacy, focus on the ocean currents of change rather than the short lived ripples.