Thérèse Coffey is an impressive force, but the disconnect between her and the NHS is telling

Disassociation has a political benefit: It makes it much easier to say that the latest crisis is someone else’s fault.

September 30, 2022 7:00 a.m.(Updated at 14:30)

One of the weirdest parts of Liz Truss excruciating round of local radio interviews Thursday morning was when he had the prime minister’s equivalent of an out-of-body experience. Speaking to his own local station, BBC Radio Norfolk, Truss was asked about the Queen Elizabeth Hospital King’s Lynn, which has such serious structural problems that it is being propped up with piles in 56 different areas of the building.

“I have seen for myself the very difficult situation with the roof,” she replied. “And of course we have a new Secretary of Health, Thérèse Coffey. I hope he will visit Queen Elizabeth Hospital soon to see the situation there and make sure action is taken.”

When the exasperated presenter pointed out that this would be the fourth health secretary to visit the dilapidated hospital, Truss responded: “I hope she’s the one to deliver.” It was almost as if she had forgotten that she was Prime Minister and was speaking as another lowly MP who might hope that Coffey could get her together soon for a quick meeting.

Mind you, Truss can be forgiven for wishing she were just a humble MP, instead of the Prime Minister making such unorthodox decisions in her first few weeks that the garbage fire resulting in the economy makes the NHS crisis seem relatively tame. Next week’s Conservative Party conference will be dominated by the fallout from the mini-budget she instructed the Chancellor, Kwasi Kwarteng, to deliver.

But people are not only worried about their energy bills, mortgages and pensions, they are also worried about whether they will get the NHS treatment they need in time. The pinch in the air reminds us that winter is coming, the time when the NHS is in crisis mode, and yet the health service is already struggling.

The NHS is unlikely to be shielded from the financial fallout: in fact, the Queen Elizabeth Hospital radio question highlighted one of the particularly neglected problems within the health service, which is that there is a backlog of building repairs and IT systems. The latest figures from NHS England put the cost of upgrading buildings and other parts of the NHS infrastructure at £9bn, which isn’t too far off the annual cost of running the NHS anyway.

Capital funding for the NHS has long been unusually low compared to other Western health systems: it is now just under 6 per cent of total health spending. It’s supposed to rise to £11.3bn by 2024-25, but as the Government tries to cut spending to pay for its tax cuts, the temptation will be to squeeze as much of it out of the departmental budget as possible. Even if that doesn’t happen, runaway inflation will squeeze the health service anyway. Higher prices mean the NHS budget won’t stretch as far.

At least the Government is prepared to admit there is a crisis in the NHS, in contrast to its finger-in-the-ear approach to the falling pound and pension shocks. Coffey, who is also deputy prime minister, is an impressive force who immediately waded into reams of briefing papers upon her arrival at the department. I understand that her speech at next week’s conference will focus on the “ABCDD” priorities of ambulances, delays, care, doctors and dentists. Her commitment to ABCDD cannot be faulted, but there are notable barriers in addition to the funding constraint detailed above.

One is that experts report a growing disconnect between the department and the NHS. This is only partly a function of the legal separation between the two agencies: the fact that the health service is operationally independent does not mean that it cannot communicate adequately with Whitehall.

What some officials are privately reporting, however, is that the physical separation between the two is having more of an impact: We all find it a little harder to understand what colleagues want and do when they work from different buildings, and the mile or The therefore between the Department of Health and Social Care on Victoria Street and the NHS headquarters near Elephant and Castle represents a gulf in understanding and communication.

It’s one of the reasons, for example, why Coffey recently insisted he wouldn’t abandon the four-hour wait target for accidents and emergencies when, er, the NHS has pledged to phase it out over the past three years.

With Truss unable to compromise with his own government to ensure the repair of a hospital supported on stilts, and Coffey compromising with something his own government agency had been trying to bring down, it’s almost as if no one in the government is talking to anyone else.

Of course, there is a political benefit to this kind of decoupling. It makes it so much easier to say that the latest crisis is someone else’s fault.