Preface to the second edition


What is the role of the health secretary, what should it be, and how does it and should it relate to the management of the NHS? This exercise was originally undertaken to explore these questions with former health secretaries – in their own words, but with some analysis. At the time of the first edition in May 2015, Jeremy Hunt had been secretary of state for a little under 2 years. As the serving minister, and for obvious reasons, we did not ask him to be included, although we did draw on an interview he gave for other purposes, as we do here.

This second edition – which may yet be further expanded as the job continues to change hands – adds the Jeremy Hunt interview. It has been written, however, in extraordinary times: near what may, or may not, be the height of the coronavirus (COVID-19) pandemic – although the interview itself took place just before the outbreak took hold, and thus COVID-19 does not get a mention.

The pandemic has already changed much about the NHS, and will no doubt change it more. This includes where relations between the politicians in charge and the management of the service eventually ends up – with judgements to be made, that cannot yet be made, about how well NHS structures, and the Department of Health and Social Care, stood up to the toughest test the service has ever faced. The pandemic has also had a profound impact on social care, the public health system, and wider services that shape our health.

In adding Jeremy Hunt’s view, we have also included a new section of analysis (The new dispensation), but we have not rewritten the first edition (though we have updated some references). We decided against that because the 2012 Act was clearly meant to define an entirely new relationship between the health secretary and the service. The intention was to create a new set of statutorily independent boards and regulators to run the NHS along much more market-like lines, with minimal involvement from the health secretary of the day. How far that has happened in practice is explored in this edition. Questions about the COVID-19 pandemic, how it was handled, and what it might mean for the role of the health secretary are for future editions of the book.

Previous Next