Matt Hancock: “We are going to make it a joy to work in the NHS”
Far from being daunted by the challenges posed at the Department of Health, Matt Hancock has taken on the brief with customary energy. Having identified three target areas in the NHS, and with the new cash settlement to play with, what does the Health Secretary have planned? He talks to Sebastian Whale
Matt Hancock was once the proud owner of a world record. In 2005, he was on a two-man expedition to the Arctic with the additional ambition (and one that secured the requisite sponsorship) of playing the most northerly game of cricket in history.
The trip was drawing to a premature close after he exposed his hands to the elements while trying to restore their ripped tent back to some semblance of use. With the rescue team mobilised, Hancock realised he didn’t have long to achieve his goal. He used ski-poles for stumps and paced out a wicket. With four of his fingers frozen solid after the previous night’s sub-40 temperatures, he was relieved to bowl his companion out for a duck.
But Hancock’s legacy – which came at the price of mild arthritis in one joint – was unceremoniously shattered by former Conservative MP Dan Byles, himself a world record holder. “You used to have a world record too,” he told Hancock. What do you mean, used to? he responded. “My mum beat it,” Byles continued.
An apparently dejected Hancock explains: “His mum had been on an icebreaker and gone on a trip to the actual North Pole. She met an icebreaker from the Indian navy at the North Pole and they got off their boats and played the most northerly game of cricket.
“That’s how I found out about it – ‘my mum broke your world record’.”
Hancock hurls me the red cricket ball that travelled with him on his trip to the Arctic. Like his dream, the inscriptions are now slightly faded. Though that coveted record has gone, he could well stake a claim to being the most energetic and enthusiastic Cabinet minister in the history of Whitehall.
He has become known for throwing himself into every situation with a self-assuredness unfathomable to those of an introverted disposition ever since becoming an MP for West Suffolk in 2010. From full-throated efforts during karaoke at Tory conferences to leaping over walls while trying out parkour as Culture Secretary, he has garnered a reputation as someone who fully commits to the task at hand.
But a move to the Department of Health could have posed a daunting endeavour. Those in charge are, often by dint of the decisions they carry out, notoriously unpopular – his predecessor being the most immediate example. Perhaps it is no surprise that Hancock wasn’t overcome with nerves about the switch.
“Lots of people have asked me whether I’ve found it daunting. The answer is that it’s a huge challenge but I’m very excited about it,” he says. Jeremy Hunt secured an extra £20bn a year for the NHS by 2023 before moving to the Foreign Office – and now Hancock’s job is to develop the plan on how to spend it (while Philip Hammond works out how to fund it).
Hancock has identified three areas of concern: workforce, tech and prevention. In his plush office in London’s Victoria, the Oxford PPE graduate (who went on to do an economics masters at Cambridge) walks me through his plans.
He has spoken of “old school management” in the NHS, where incidents of bullying and harassment are “too frequent”. “Working in the NHS should be an amazing experience. It’s a huge team effort to try to help the nation to be as healthy as possible. The vast majority of people in the NHS are driven by that mission. So, I don’t want it held back by a tiny minority who think that it’s okay to behave unreasonably, and I’m going to call it out,” he says.
Is this behaviour having a material effect on retention? “I want to see the overall morale of the workforce rise, and tackling bullying and harassment is part of the answer to that. Of course, there’s lots more to improving the morale of the NHS workforce. But that’s part of it.”
As he gazes off into the distance contemplatively, a half-eaten apple slowly oxidising in his left hand, Hancock seems invigorated by the challenge of improving the lives of NHS workers.
“We are going to make it a joy to work in the NHS,” he says, drawing eye contact. “Rather than people feeling mission driven by their job despite the system, I want them to feel the system is supporting them.”
In real terms, he would like to see leaders at a local level in the NHS instil a “collaborative, non-hierarchical structure where everyone works together”. He is in conversation with the British Medical Association about what can be changed at a national level to how clinicians work and are given professional development. He also sights “contractual issues” that need to be addressed and wants to promote greater use of e-rostering to reduce agency staff spending and bolster flexibility for NHS workers.
A change of culture is also in his sights. In an interview with The House in June, Health minister Jackie Doyle-Price said that women often feel “patronised” and “diminished” by doctors and, as a result, are forced to “suffer in silence”.
Hancock points to the example of vaginal mesh, which was prescribed as a treatment for mild incontinence and has been linked with life-changing side effects for many women. A leading consultant who fought against the use of mesh, he continues, told some “extraordinary stories” about how her efforts were “belittled”. “So, right across the board there’s a culture change that’s needed to be open-minded to everything,” he adds.
Hancock’s second target area is around prevention. The public health agenda does ostensibly seem anathema to Conservative ideals – it is based around the government intervening in matters of life choices. But it is one the party has embraced in recent years, with two iterations of a childhood obesity plan as evidence. Hancock says the government can now be “much more targeted” with its campaigns, such as encouraging pregnant women to stop smoking. “So, you don’t necessarily have to have blanket policies,” he adds.
Hancock took part in a jog with pupils from a primary school in London as part of a new ‘active mile’ scheme. Is he still doing his daily run? “I try to do a mile,” he replies with some ambiguity. Does he get his five a day? Turning his head to what’s left of his apple, he lets out a laugh. “I’m definitely five a day.”
The challenge with health policy is that increasing life expectancy could then put pressures on to other areas such as social care (which Hancock announced £240m earlier this month to stave off yet another winter crisis. The government’s green paper is expected before the end of the year).
But Hancock argues that keeping open community hospitals to alleviate pressure from acute services – which is “where the majority of costs go now” – and taking a lead on public health, saves money overall.
“Life expectancy increasing does shift the burden of disease from some of the acute killers of late middle age if you like – stroke, heart disease, cancer, which have been falling rapidly over the last generation – onto the diseases of old age like dementia and Alzheimer’s. But that’s a good thing – that’s because people have survived longer to the point where you’re more likely to suffer from dementia.
“We need to treat those diseases too and they’re treated in different ways. But overall, preventing ill-health saves money. That’s one of the reasons it’s a big focus of mine.”
He adds: “You want people only to go to use their GP or hospital when they need to, but on the other hand, when they do need to, we need them to go. It’s part of the prevention agenda because they can pick up problems earlier if you get it right.
“We have one of the best systems for treating cancer once it’s discovered in the UK. But, our cancer survival rates aren’t nearly as good as comparative countries because we don’t pick it up early enough. So, the system doesn’t spot the signs and individuals don’t present with the very early signs, you need to have the primary care and community care out there in the community preventing these problems getting worse.”
Hancock, familiar with the topic from his days in DCMS, has taken a tough stance on social media companies as he seeks to cut down on mental ill health among children and young people. What is behind the recent rise? “It’s a combination of prevalence and being more willing to talk about it. I definitely think social media has got a part to play. If you look at the figures, there’s an increase in self-harm amongst teenage girls but not amongst teenage boys. And that implies that something happened in the last decade to increase the pressure on teenage girls,” he replies.
“Now, thankfully that hasn’t yet been reflected in a material change in suicide rates, which is the ultimate failure of somebody’s mental health – suicide rates are currently at a seven-year low. But that implies that there is a problem in terms of the pressures being put on teenage girls and the consequences for their mental health.”
Hancock, who has young children, does not allow them to use social media (phones are allowed as “sometimes you do need to talk to them”). In early October, he asked the Chief Medical Officer, Dame Sally Davies, to draw up guidelines on social media use by children.
“The terms and conditions of the main social media sites are that you shouldn’t use it under the age of 13, but the companies do absolutely nothing to enforce against that. And they should, I think that should be a requirement,” he says.
“You shouldn’t be on WhatsApp, according to their own terms and conditions, before you’re 16. And yet, the pressures that people feel under when they’re on a WhatsApp group to wake up in the middle of the night to get back to messages – this is teenagers or young kids who aren’t even teenagers yet.
“So, if the company say that you shouldn’t be on it till 16, they should do something about that and they should empower parents to allow it to happen.”
Is the general rise in reported mental health problems due to an increased willingness to talk or because of challenges unique to today?
“It’s a combination of the two. My reading of the evidence is that it’s undoubtedly easier to talk about mental health issues than it was a generation ago. That is unambiguously a good thing,” he says, praising MPs such as Charles Walker who have spoken publicly of their own experiences.
“There are also signs of an increased prevalence of mental illness that needs to be addressed and there’s certainly more pressures,” he continues, once more referencing social media.
“And in a way, society as a whole – and work in particular – has moved from relying on your brawn and physical capability a generation or two ago to relying on your straight-line, cognitive thinking maybe a few years ago, to increasingly relying on your emotional intelligence.
“The health system needs to make the same journey from focussing on the nuts and bolts of people’s bodies to concentrating increasingly on ensuring the whole person’s physical and mental health is supported.”
He adds: “The best doctors have always understood all of that. The training increasingly includes the human and emotional side. For instance, doctors are actively trained now how to impart difficult messages to patients. But the overall system needs to clearly move in that direction.”
Hancock looks taken aback as I ask, is politics good for your mental health?
“Politics is a highly stressed occupation, but it’s also one where you have a sense of mission and a sense of duty and is very gregarious. Those three things are definitely good for your mental health, but some of the stresses and strains are a challenge,” he says after mulling it over.
His final strand is on tech and one in which Hancock (who has an app named after himself for his constituents) has carved out his niche in recent years. Was he surprised by the standards and use of technology in the NHS? “No, I knew that it left a lot to be desired,” he says laughing. “Having driven tech transformation across other parts of government, it’s something that I can bring to the table.”
He believes that patients’ health can be improved through developments in genomics and artificial intelligence. More refined IT systems could make life easier for clinicians and patients, he continues, to allow greater flexibility in booking appointments and managing them, as well as overseeing ongoing health conditions.
“So, all the way from the basic logistical improvements that will cut waste, through to using cutting-edge technology to treat cancers and rare diseases, there are massive opportunities,” he says.
The issue of most immediate concern to some in the health service is Brexit. What can Hancock say to assuage the majority of medical professionals who, according to a recent YouGov poll, think the NHS will deteriorate after leaving the EU?
“I don’t think it needs to be detrimental to the NHS. Of course, we’ve got to prepare for a no deal scenario, but I don’t think that’s the most likely outcome. We’ve got to make sure that we continue to attract the brightest and best from around the world. Other than that, there’s no reason that Brexit shouldn’t be anything other than a positive experience for the whole country, so long as we ensure that we are future-focused, outward-looking and international,” he says.
It is not only on Brexit where Hancock’s views differ from his former boss, George Osborne (he served as Osborne’s chief of staff from 2005 after working at the Bank of England. Both voted Remain, but Osborne has taken a tougher pro-EU line). He has called for calm throughout the tumult of the past 18 months and pledged loyalty to Theresa May. What is his message to his warring party?
“Everyone should get behind the Prime Minister, who’s in the best position to deliver a good Brexit for the country. And we should be united in serving the country that we love and ensuring that biggest catastrophe that could befall the politics of this country is avoided and Jeremy Corbyn is always kept out of power,” he says.
Over the weekend, some of Hancock’s colleagues give incendiary briefings to the Sunday newspapers about the Prime Minister. “People in public life have got to be very careful with their language. Being an MP, being in public life is a great privilege. But it comes with responsibilities. We’ve got to remember the people who we serve in all this,” he says. “My attitude is to be a forward-facing, future-facing Conservative who wants to solve problems for my constituents. And it’s frustrating when the mass focus, and the language of politics, is all focussed around one subject and can be quite negative.”
The mother of a former Conservative colleague erased Hancock’s name from the world record books. But what would he like his legacy to be at the Department of Health?
“I’d like a better relationship between the system and the workforce who comprise the service. I’d like better prevention and, crucially, link up to the local authority-provided services including social care and public health. And I’d like the NHS to use the best available technology and be one of the most technologically advanced in the world,” he says.
“I picked three priorities because if you have more than that, you end up having none at all.”