A warm welcome from Sir Trevor

Letter from Sir Trevor Longstay to the new secretary of state for health, Matt Hancock

Dear Matt

Congratulations on your appointment. The fact that so few have heard of you only serves to make your achievement the more remarkable.

As the leader of one of England’s foremost health economies, I am often asked what I most value in a secretary of state. My answer is always the same: a leader who is unafraid to keep a low profile, preferably someone with little or no knowledge of or interest in the NHS, and someone thrust into the job at short notice. So far, so good.

I know you will not wish to waste the opportunity to hear from those, like myself, who work tirelessly at the front line before rushing to judgement on matters of policy.

Your predecessor, as I’m sure you know, was in the job for several years. I have every confidence that you won’t make the same mistake.

As he grew in experience, Mr Hunt began to imagine that he was in some sense “in charge”, an attitude which to borrow a footballing expression may sometimes have lost him the dressing room. 

Suitable hobbies for ministers

Successful health secretaries, in my experience, are those who have ideas but do not try to get too much done. Mr Hunt generally performed this part of the role well. He sensibly took an interest in patient safety, where after adjusting for the effects of chronic under-funding one can show that he did no harm. Indeed he made some very good speeches.

Mr Hunt’s other big NHS-related interest was IT, another low-risk area where an incoming health secretary can really expect to deliver, rhetorically speaking. A paperless NHS, he correctly argued, would not only be more modern and more digital, it would be cheaper and therefore safer. Mr Hunt was only let down by his rash prediction that it would happen in his lifetime.

Undeterred, he published research to show that the public generally prefers apps to doctors and that all but a cohort of older patients (who do fully understand new technology) would rather have Amazon vouchers and manage their own care than pay more in taxes.

The Department of Hancock

I see that you have also expressed keen interest in IT and once published an app bearing your own name. There may be other branding opportunities in your new job, minister, but approach them with caution. The Matt Hancock Department of Health and Social Care may be appealing now, but could make things difficult should you ever need to distance yourself from any of your department’s decisions.

Similarly, you may be tempted to lend your name to the new NHS long term plan. The Matt Hancock Plan has a nice ring to it, but remember that like your predecessor you may wish to make it clear during difficult moments in Parliament or on Radio 4 that this is the “NHS’s own plan” or another one of Stevens’ efforts, and as such nothing to do with you.

Here to help

I am sure I can speak for other very senior NHS leaders throughout the country in wishing you every success in your new post. We are here to help you deliver the changes you want to see by reporting the outcomes you promised to deliver, whatever they happen to be. It goes without saying that the more modest and vaguely defined the outcomes, the more frictionless the reporting process.

Previous health secretaries have sometimes made the mistake of taking too close an interest in the operational detail, the so-called facts and the data on which we base our planning assumptions and financial accounts, but relationships cannot flourish in an atmosphere of intimidation and mutual distrust. I hope I make myself clear.

Just before news of his departure, Mr Hunt called me at home to tell me that he was planning a substantial uplift in funding for NHS Blithering so that we continue the work of our vanguard in bringing standards of care very close to the average for a low-performing STP area. I think the sum mentioned was £50 million, recurring.

Our bank details are below. Please let me know when the funds are in so we can reopen the children’s ward and keep up the fantastic work of the Sir Trevor Longstay NHS Trust (formerly known as St Mary’s Hospital) in meeting its PFI commitments.

On a personal note, I greatly look forward to working with you. I would be honoured to put my 40 years of NHS service at your disposal in an advisory capacity. I have taken the liberty of enclosing my business card and fee schedule.  

Yours with warm good wishes

Sir Trevor Longstay

Editor: Julian Patterson


Reproduced at TrainingPrimaryCare.com by kind permission of Julian Patterson.