Britain’s new health boss sparks cries of cronyism

“It is quite unclear what Baroness Harding brings to this role. It is true that she will have learned from the many mistakes in setting up the English test and trace system, but this is not a post in which we should expect the appointee to learn on the job,” said Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine.

Those who have worked closely with Harding are effusive about her, citing her energy, candidness and intelligence.

“Fresh thinking, deeply analytical, but quite politically savvy and a very people-focused approach,” is how one former colleague at NHS Improvement described Harding.

Health and Social Care Secretary Matt Hancock clearly agrees. “Having somebody with enormous experience both running very large organizations in the private sector … and huge experience of health; she has what it takes to lead this organization,” he said this week. Government officials said her “track record building and growing” major private sector firms makes her ideal to launch the new agency.

What undoubtedly taints Harding most is the 2015 TalkTalk cyber attack, during her tenure as CEO. A hard blow to her reputation, the attack cost the company an estimated £77 million and resulted in a record fine of £400,000.

“I think if she were being candid perhaps and had her time over again she might respond to it differently,” said a former colleague of Harding’s at TalkTalk. Despite the challenges at TalkTalk, Harding was “very well thought of” across the organization, the ex-colleague said.

Hard on bullying

While Harding’s move in 2017 from TalkTalk to NHS Improvement may have blindsided those working in public health, it wasn’t a surprise to those at TalkTalk. “She wanted to turn her guns on something that was perhaps more socially impactful,” explained the former colleague.

Even at NHS Improvement, her appointment was broadly welcomed, with Harding bringing “huge energy and enthusiasm,” said the previous colleague at the watchdog.

There, Harding focused on cultural reforms in the NHS — an organization known for longstanding workforce issues. “It’s awful,” said Harding of the levels of bullying in the health service during a 2018 interview with the BMJ. “The percentage of staff saying that they have been a victim of or have witnessed bullying is three, four, fivefold more than you would see in other organizations.”

The issue would become her hobby horse, with Harding taking on the daunting task of the NHS People Plan — a document finally published in July that sets out what needs to change within the workforce.

“The area of workforce in the NHS has been a difficult one for a long time [there have been] a lot of promises,” said an individual who worked with Harding on the plan. “A lot of promises to improve culture, remove bullying and of course, difficulties with workload for staff. So you wouldn’t want to start from where Dido and the team had to begin.”

Despite having every reason to be skeptical, the individual working with Harding on the plan said they were “pretty impressed” with how she managed the mammoth task. “There was no attempt by [Harding] to paper over some of the difficult issues and a real sense of determination to engage.”

It’s this candidness that former colleagues seem to be most impressed by.

“She gave a lot of herself and she spoke very candidly and very openly,” said her former colleague at TalkTalk, of her time there.

‘An imposter’

The same ex-colleague also isn’t particularly worried about Harding’s latest move to interim head of the new National Institute for Health Protection, despite her lack of experience.

“She’s very good at identifying quality people and getting them close to her [and] using their knowledge. So I would imagine even though she’s not an expert in this space, she won’t be shy in surrounding herself with people who absolutely are,” said the former colleague.

Even Harding makes no secret of her lack of health care experience. In fact, in a 2018 debate in the House of Lords she admitted that she felt “like a bit of an imposter.”

Public health experts are highly skeptical of a former businesswoman heading up a public health agency, even temporarily. “Looking globally at public health agencies around the world they are almost, without exception, led by people who are either clinically qualified or they are epidemiologists, public health experts,” said Linda Bauld, professor of public health at the University of Edinburgh.

Hancock and colleagues counter that Public Health England’s setbacks responding to the pandemic — which the NIHP is supposed to resolve — did not stem from a lack of epidemiological expertise, but an institutional failure to scale up its response in time. PHE was regarded as “good at the science” but bad at delivering at scale, said one government official. So — the argument goes — the person at the top needs to be an organizer, not necessarily a scientist.

Privatizing health care

But many public health experts point to problems with the test and trace system as, at least partially, a failing of Harding’s. In England, contact tracing has been mostly outsourced, with Public Health England teams working only on cases identified as “complex.”

“It’s not the model that those of us working in public health would have recommended,” said Bauld. Data published August 20 indicated that since the test and trace program was launched, 97.7 percent of all complex cases’ contacts were reached by PHE and asked to self-isolate compared to 58.7 percent of the outsourced, non-complex cases.

“This government approach is to disinvest in public services and instead they channel money to private firms with a view that they can do things more efficiently. But I think today test and trace gives us pretty clear evidence actually that [PHE] can do it more efficiently,” said Bauld.

Harding’s affinity for the private sector was first revealed in 2017, when she came under fire for not giving up her private health insurance despite gunning for chair of the board of NHS Improvement. According to the Independent, when being quizzed by MPs before her appointment, she said she didn’t believe giving up her private health care would send a “positive message.”

“I think we’d be cutting off our hand to spite our face if we demonize private health care,” said Harding at the time.

Jobs for pals

Harding’s close political ties are no secret. Herself a Conservative peer in the House of Lords, her husband John Penrose is the Conservative MP for Weston-super-Mare. Much has already been made of Penrose sitting on the advisory board of 1828, a think tank that believes Public Health England should be scrapped and the NHS should be replaced by an insurance system.

She attended the University of Oxford alongside David Cameron, who later went on to give Harding a peerage. Her passion for horse racing is also shared by Hancock, whose constituency houses the Jockey Club — Britain’s main horse racing organization, on whose board Harding sits.

“We’re all acutely aware of her strong links into politics,” admitted the former TalkTalk colleague.

Her loyalty to the party was evidenced in 2017 when despite calls from the House of Commons health and social care committee headed by then Tory Sarah Wollaston, to give up the Conservative whip, Harding refused, describing it as “tokenistic.”

But for many health experts, the recent appointment was nothing more than thinly-veiled cronyism.

“I have got concerns why she was appointed to such a critical role, especially at the time of the biggest crisis we are facing globally when any restructuring would be a setback,” said Patty Kostkova, professor in digital health and director of University College London’s Centre for Digital Public Health in Emergencies. “It gives the impression of nepotism.”

Kostkova said that there was “no accountability and transparency” in Harding’s appointment and that she hoped that the appointment of the permanent director of the organization would be “through an open and transparent selection.”

On the cronyism charge, the government official questioned whether making someone head of a high profile health organization in the midst of a pandemic (for no money) was the kind of gig you’d hand to someone as a reward. It’s not as if Harding was given “a governorship to some exotic Caribbean island,” the official said.

Ultimately, what’s most concerning for those in public health is the restructuring — mid-pandemic — of a critical organization; one whose staff are still weary from a restructure in 2013 that Kostkova described as “difficult and painful.”

“I’m sure she is doing it partly out of public spirit but I do hope it doesn’t turn out to be a poisoned chalice,” said the individual who worked with her on the People Plan.

Her former colleague at NHS Improvement agreed that Harding will face an uphill battle in her new role, but said she was resilient “and she believes in doing the right thing.”

However, the impetus for taking up the post might not be just down to altruism.

“She’s highly ambitious as well, let’s not think otherwise. That ambition is born out of wanting to get results and do the right thing… And you know there are casualties on the way. She can be pretty ruthless when she needs to be,” they said.

Additional reporting by Vincent Manancourt.