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So… it’s Yvette Cooper.
Andy Burnham’s new Health Secretary arrives from the Foreign Office, having previously run the Home Office.
At first glance, another politician without much recent NHS experience…
… look again.
Cooper was elected during the Blair landslide in 1997.
She has been...
- a junior health minister,
- a housing minister,
- Chief Secretary to the Treasury,
- Work and Pensions Secretary,
- Home Secretary.
- Foreign Secretary…
... there are few corners of Whitehall she hasn’t seen… that matters because…
… the health brief is no longer simply about running the NHS.
It is about money, legislation, local government, workforce, public consent and persuading the Treasury to do things it would rather not do.
In other words, it is a job for a heavyweight, and… Cooper’s appointment tells us Burnham knows it.
The immediate NHS problem is brutally simple...
... around 1.7 million treatment pathways are joining the waiting list each month. Around 1.4 million are leaving it.
Three hundred thousand more arrive than are dealt with.
Treating more people is part of the answer, but it cannot be the whole answer.
Either; productivity has to rise sufficiently to close the gap, fewer people must arrive needing treatment, or patients must be diverted into alternatives that work.
Probably all three.
That means better use of theatres and diagnostics, fewer cancelled appointments, more effective referral management and serious investment in prevention.
Not slogans…. flow!
Cooper’s Treasury experience will delight the Jim Reaper, who has made a career of defeating them. Cooper knows how to distinguish between activity and productivity, and…
… recognise that every promised improvement has to be paid for.
Then there’s social care.
This is where her wider career may be even more useful.
She has worked in housing and local government, where the realities of care, are lived.
She has run Work and Pensions, where disability, poverty, employment and caring responsibilities collide.
She has led the Home Office and Foreign Office, departments that depend on coordination across government and negotiation with people who often disagree.
Social care requires all of those skills.
Creating a National Care Service sounds simple… it ain’t!
It requires…
- legislation,
- structural reform,
- workforce planning,
- new relationships with councils and providers, and...
... bring money… shed-loads.
The first question is what the state will pay for, what individuals will contribute and what families will still be expected to provide.
That’ s the question every government has avoided. Cooper may be well suited to forcing it into the open.
Her experience chairing the Home Affairs Select Committee also matters. For five years, she worked across party lines, investigated difficult issues and built arguments rather than merely issuing instructions.
If Burnham genuinely wants a lasting, cross-party settlement for social care, that may be more valuable than detailed knowledge of NHS management.
The Better Care Fund could provide a pragmatic place to start. It already creates pooled NHS and council budgets.
Strengthen it. Simplify it.
Give local leaders more freedom to spend around the needs of people rather than the boundaries of organisations...
... that’s very burnished Burnham.
It is not a substitute for a funding settlement, but it may be the bridge between today’s fragmented arrangements and whatever comes next.
Cooper’s weakness is obvious…
… her direct health experience is nearly a quarter of a century old. The NHS she knew was very different from today’s vast, digitally dependent, operationally fragile system, but…
… Burnham knows health.
A Prime Minister who understands the NHS, alongside a Health Secretary who understands Whitehall, the Treasury, legislation and political negotiation.
Cooper does not need to invent more initiatives and performative policy announcements, please... no.
In the 145 weeks until the next election, the NHS has to improve its weekly waiting-list performance by almost 100,000 pathways...
... while undergoing its biggest organisational reorganisation in a decade.
Cooper has a choice. Push harder on productivity, reduce the numbers joining the queue, or reframe the reorganisation that risks distracting the NHS from both.
The blunt truth is she can reorganise the NHS, rescue its waiting lists and reform social care. Try all three at once she'll deliver none of them.
Three enormous jobs.
The surprising conclusion may be that Yvette Cooper is one of the few people in Westminster with the experience, authority and political stamina to attempt all three.
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