Therese Coffey opens the door to more foreign nurses to plug NHS staff shortage

Therese Coffey says she wants to 'make sure we've got the right number of people' in the NHS, as she deals with a large backlog - Geoff Pugh for The Telegraph
Therese Coffey says she wants to 'make sure we've got the right number of people' in the NHS, as she deals with a large backlog - Geoff Pugh for The Telegraph

As a front-line politician, few experiences can be as frightening as beginning to lose the ability to form words. “It was quite an odd week,” Thérèse Coffey recalls with understatement.

The new Health Secretary and Deputy Prime Minister is still settling into the briefs handed to her by her friend Liz Truss, a double role that confirms her centrality to the Government.

But speaking to The Telegraph in her first newspaper interview since the promotion, Ms Coffey begins by looking back to spring 2018, when she saw the NHS at its best.

The Tory MP for Suffolk Coastal and, at the time, environment minister had caught an ear infection and had it diagnosed. But as the days wore on, the problem would not clear.

“I was still able to function, this is the issue,” she recalled. “I did a Westminster Hall debate. I gave a speech. I was just in a lot of pain and I knew something wasn't right.

“It was thanks to my sister phoning the A&E in St Thomas’s to say: ‘I've never, ever known my sister like this ever before’. So they did an MRI scan and then I was whisked into hospital.”

The infection, it turned out, had spread to part of Ms Coffey’s brain. An emergency operation followed. In the weeks of recovery that came next, remembering words proved tricky.

“If the infection had been on this side, the reaction would have been a lot more physical,” said Ms Coffey, tapping the unaffected part of her head. Instead, it was language that suffered.

“I had to rewire my brain a bit to do sudoku, all that stuff. I couldn't even remember what was on my feet. My sister told me it was ‘slippers’.

“So I've rebuilt a lot of words. Even now, there are phrases that if I haven’t used them - I mean I’m probably past that by now - but I have to think it through.”

She added of her recovery: “The brain is an amazing thing.”

Such an intense experience with the UK healthcare system has brought a degree of personal understanding to her new brief that other past health secretaries may have lacked.

Perhaps it gave her a deeper sense of what it means to be reliant on the NHS? “Absolutely,” she said without pause. “I'm very conscious of that.

“The NHS tends to be brilliant in an emergency, absolutely amazing. We just want to continually try and see what works really well in some parts of the NHS.

“I'm finding that very interesting already. Just the complete variation in patient experience. There are some things we need to address more significantly, I get that. But that is one of the things where we can, I hope, get some impact pretty quickly.”

Tory cabinet ministers come in all shapes and sizes. There are egotists, there are orators. There are those better at television appearances than policy delivery, and vice versa.

Ms Coffey comes across as a pragmatist. She developed a reputation as a details person in her last brief at the Department for Work and Pensions, able to understand the complexities of the Universal Credit system and how to tilt the incentive structure while helping the most vulnerable through the strains of the Covid-19 lockdowns.

In the new job, Ms Coffey has come up with her “A, B, C, D” - ambulances, backlogs, care, and doctors and dentists.

Policy development is still in its infancy. She has been in the job less than a month and wants to set priorities and principles, before drilling into each problem area.

But during the conversation on the side of Conservative Party conference in Birmingham, Ms Coffey shone light on some of the big challenges in her brief.

The “B” in her alphabetical target list, “backlogs”, is one the public is watching closely. Some 6.7 million people are on NHS waiting lists in England, with many voters knowing someone who has a story of shocking delays.

Ms Coffey has said GPs must offer non-urgent appointments within two weeks. She will also publish what has been dubbed “league tables”, effectively naming and shaming those practices with the longest wait times.

“It's not so much league tables. It’s about having transparency,” she explained. “That will allow us to have a bit more laser-like focus, frankly, on trying to deal with what's happening there.

“It's a variety of things. One of the beauties of being, of course, a constituency MP is that you see this directly yourself and you know where the best practices are and you know where the people are struggling. Having that kind of greater understanding right across the NHS network I think will be really helpful.”

She countered suggestions it is too harsh, saying: “It’s not about criticising, it's about: 'This one's doing brilliantly this other one isn’t.' They're not doing that on purpose. But it's to try and make sure that appropriate interventions can be offered.”

What about some areas Ms Coffey is yet to share her views on? For one, the persistent shortage of doctors, nurses and social care workers right across the country.

Her predecessor in the department, Steve Barclay, went public during the brief months he held the job saying that more foreign workers were needed to plug gaps.

Does Ms Coffey want to increase the number of foreign visas for healthcare workers? "I just want to make sure we've got the right number of people,” she said. “I don't mind if they are coming from abroad or are home-schooled here.

“But I think it's important recognising there's quite a lot of people who no longer want to work permanently for the NHS.”

Ms Coffey said she will not “sit here and write a complete NHS human resources plan”, noting recent rule changes that allow more overseas care workers to come to the UK.

So it sounds like you would be supportive if an increase in foreign healthcare workers was needed? “Yeah,” she said. “I think it's a case of recognising there's a lot of vacancies. That's what trust tells us.”

The position foresees a tussle coming for the Truss government - between department heads who want more foreign workers to help fill skills shortages and others, not least Suella Braverman, the Home Secretary, pushing to bring down overall immigration numbers.

On other areas, Ms Coffey is less willing to bite. There has been concern about the scale of part-time work from GPs.

Just one in four GPs works full-time. Many are working three days a week. At the same time, getting face-to-face appointments is becoming a major challenge.

Is that a concern? “A lot of investment goes into people's training and if it's just part-time work, then that's perhaps not what was anticipated when people signed up to that,” said Ms Coffey.

“But nevertheless, they tend to be self-employed. I mean, they're independent contractors, or they might be salaried within a practice, and I'm not going to start condemning people who move to part-time work.

“I appreciate there are some people who think that's outrageous, but we just got to work with how people want to live their lives.”

Likewise, there is little appetite for private healthcare reform. The curiosities of the system have been noted in the past - that those who opt into private healthcare at work still pay tax on contributions and private GPs are often not able to write NHS prescriptions.

Is there danger people who choose private health care are discriminated against versus the current system, perhaps? “No,” came the one-word reply.

“At the moment, I'm not trying to fix private health care. What I've said is where there is a capacity within the independent sector and we want to get on with backlogs. That might be an appropriate way that we can and should use it, if that helps patients. But I'm not setting out on a private health agenda.”

Ditto, there is no change expected in Covid-19 vaccination policy. Among the public only those who are aged over 50, at high risk or pregnant can get a booster jab.

Will vaccines be opened up to younger age groups? “So far the clinical advice has been that it's not necessary,” said Ms Coffey. In other words, unless the advice changes, no.

The willingness to knock back possible reforms not seen as priorities matches the attitude of the Prime Minister's approach across government.

There is only, at best, a little over two years before the next general election. The message has been that delivering on a small number of top issues trumps scattergun announcements.

But one issue approaching at pace for healthcare cannot be avoided - the budget crunch.

When Boris Johnson revealed his flagship social care reforms, he announced £13 billion in extra spending. The catch was that it would first go to the NHS, to help tackle backlogs. Then, at an unnamed point in the future, that money would move across to fund the lifetime cap on social care costs.

Ms Truss wants that money switch to happen before the next election. But that means a £13 billion NHS funding black hole is looming. Plus, the way Mr Johnson was raising the cash - a 1.25 per cent in National Insurance - has just been scrapped.

So, Ms Coffey, are healthcare spending cuts coming in the next two years? “Obviously the Chancellor will be saying more next month,” said the Health Secretary.

“The projection of the previous administration had been to increase public spending significantly, actually. And clearly the path of this administration is to try and grow the pie and encourage people to come and be entrepreneurs here, to make money here, to employ people here on higher pay.

“So it's not about trying to do down. But I think it's getting the right balance. And that's clearly more a matter for the Chancellor, I think is the best way of putting it. My experience of Liz is she's a very principled, pragmatic person who set out a clear trajectory during the leadership contest on this approach and that's what we will get on and deliver.”

The response sets out the big picture but carefully steps around the question. Given how often that question will be asked in the coming months, one senses more specificity will be needed in the future.

Ms Coffey has been an MP for 12 years but remains little known among the wider public, something likely to change now. Even this year at Tory conference, she is being mobbed by excited loyalists far more than usual, she said.

There was much hilarity in her first week in office when, during a live interview on LBC, her phone started blasting out the 1999 rap hit “Still D.R.E.” “You’re getting a bit of Dr Dre,” the 50-year-old Health Secretary muttered as she moved to silence it.

So, is she really a fan of the US rapper? “I do quite like that sort of music but I’m not solely focussed on Dr Dre," she said. "Look, I have different ringtones for a few different things. So my mum's number is Mamma Mia.”

Dre, sadly, is her alarm rather than the song for a particular MP.

Ms Coffey’s rise to the number two spot in British politics was not a straight line. She followed in the footsteps of the grand dame of Tory politics, Margaret Thatcher, by studying chemistry at Oxford University’s Somerville College, but did not complete the course.

"It didn't all work out. I dropped out in my second year," she said. "There's another politician who I won’t name in the opposition who also dropped out of the same course. But I landed on my feet.

“You learn a lot about people when things go wrong and then how they recover. I don't dwell on it, can't change it. All I can do is change the future. It happens a lot in life. It's how you react and respond and strive to do better. It’s the reason I did a PhD.”

The doctorate in chemistry at University College London meant she met a current occupant of Downing Street. Not Liz Truss, one of her closest friends in politics, but the Prime Minister’s husband, Hugh O’Leary.

“Hugh and I knew each other at university as London students. We weren't close friends, but we knew each other,” she said.

Ms Coffey did not campaign with Ms Truss in the 1990s, despite some media reports to the contrary. But they did square off to become the Tory candidate for South West Norfolk. Ms Truss proved the victor - but agreed to help Ms Coffey find another seat.

“I remember meeting up before the campaign in some supermarket in Norfolk, meeting the girls [Ms Truss has two daughters]. We’ve just been mates since,” she said.

Liz Truss and Therese Coffey, pictured arriving at the Tory conference in Birmingham, are known to be close friends - Geoff Pugh for The Telegraph
Liz Truss and Therese Coffey, pictured arriving at the Tory conference in Birmingham, are known to be close friends - Geoff Pugh for The Telegraph

Can the Prime Minister rebound from the polling plunge? One poll put Labour 33 percentage points ahead last week. Many Tories are gloomily predicting election defeat.

Ms Coffey knows Ms Truss better than most. What does she see in her friend that the public, who have taken an early dim view of her premiership, are missing?

“She's got intellect, there’s no doubt about that,” said Ms Coffey. “She's got integrity. She personally stands by her word and all the rest of it. And she has got really good instincts.

“She strongly believes about growth, about not being a high tax country and taking advantage of what we have there. But her instinct on politics is really good. I'm sure that we will continue to see that flourish.”

If Ms Truss is to lead her party and the country out of this tight spot, she will need every ounce of political nous - and help from Ms Coffey - that she can muster.