Steve Barclay is the new Health Secretary. This is a fascinating move for both political and policy reasons. The first is that it is an admission by the Prime Minister that his current Downing Street operation is not working: Barclay was the chief of staff brought in to ‘get a grip’, and there has manifestly not been much of that. The second is that Barclay is, to put it mildly, a hawk on health spending. He was a Health Minister before becoming Chief Secretary to the Treasury, and formed an extremely sceptical view of the health service and its ability to waste money while in that position.

By the time he moved to the Treasury, he was prepared to push back against requests for funding for the health service – including the vaccine programme, which was not signed off officially for ages on the basis of ‘value for money’. By the time the money for the resources had gained official approval, the NHS had already vaccinated close to a million people. Barclay also gained a reputation for taking a close interest in the operational workings of individual hospitals.

This is all significant as the NHS is currently being asked to double its efficiency to 2.2 per cent a year, which is quite an ask, to put it mildly. NHS senior figures have been pushing back against any suggestions that the health service will be expected to make any further savings. Last week its chief executive Amanda Pritchard laid down a marker in a speech to the NHS Confederation, saying:

‘We must be realistic. So far, we have absorbed the current inflation spike. But budgets can only ever stretch so far.’

Barclay’s biggest challenge, of course, is the enormous waiting lists that the NHS is dealing with following the pandemic. They are projected to reach around nine million (in an optimistic scenario) around the time of the next election. Already the front pages about the number of people dying on these waiting lists are horrifying. The latest wave of Covid has made the process of tackling that backlog much, much harder.