Cowper's Cut 186: Plan B debate masks the lack of any real NHS recovery plan
I really like Plan B.
The musician Plan B, that is.
I’m less keen on the Government’s Plan B for dealing with the Covid resurgence that’s been well under way for over a month now is essentially wearing facemasks indoors; more Government communications about risk; and advising people to work from home.
Plan B: underwhelming and undermined
It’s underwhelming. More to the point, it’s being undermined by none other than this Government. Although power-posing Sajid ‘The Saj’ Javid half-heartedly endorsed their use at this week’s Downing Street Briefing, care minister Gillian Keegan this week said that “we shouldn’t make it (mask-wearing) a sign of virtue or not.
“More people will start to wear masks as we get into winter but it’s not very comfortable sitting there for hours in a mask. I’m sure everybody [in the House of Commons] has been vaccinated and everyone will get their booster”.
Ah. Right. Thank goodness MPs never, ever mix with non-MP people, eh?
Ms Keegan’s kvetching came on top of Commons Leader Jacob Rees-Mogg’s comments on Thursday that Tory MPs don’t need to wear face coverings in and around Parliament because of their “convivial, fraternal spirit”.
Mmmmmmm.
And Rishi ‘The Brand’ Sunak, challenged on ministers’ non-mask-wearing ibn the Commomns Chamber on The Meh Show, BBC1, replied, “Government guidance is for people to make decisions based on what they think is appropriate for the circumstances they’re in. Every workplace is going to be different depending on how many people are there; how long you’re there for; whether you know the people or not …”
Right.
So let me get this straight.
We’re relying on a Plan B which mainly involves a) the facemasks that ministers are consistently dissing rather than doffing, and b) the Covid19 comms skills of people who think that knowing someone and having convivial spirit protects against breakthrough Covid19 infection.
We are in absolutely no way fucked, then.
More leaks than the Welsh
Mr Sunak also told The Meh Show “there is a long history and tradition of using National Insurance to fund the health service in this country”, defending the non-progressive nature of the use of NI for the forthcoming Health But Social Care Levy.
So that’s nice.
The weekend papers were a bucketful of leaks about his upcoming Budget and Comprehensive Spending Review.
The Telegraph had news of plans for an additional £5 billion to digitise the NHS and reduce the massive £9bn+ maintenance backlog. The Sunday Times trailed a re-announcement of the new community diagnostic centres; and the Javid plan to force NHS staff to have mandatory vaccinations. This morning's Guardian has a bit more detail.
(The Alan comeback trail is very supportive of more digital, obvs.)
There was also an announcement from the Treasury itself of a £5 billion boost for research and development. Aiming ‘to spur innovation in healthcare’, the money will go to organisations like the NIHR, Genomics England and the Advanced Access Collaborative.
Lawson returns
You might think that a Chancellor who has the portrait of Thatcher’s Chancellor Nigel Lawson on display in the Treasury would be well-inclined to bring Lawson back.
And that is exactly what they have done. The Telegraph revealed that Emily Lawson, the woman seconded from NHS England to the 10 Downing Street Delivery Unit, is being seconded back to un-screwing up the vaccination programme. So did HSJ.
It’s difficult to know whether this is a smaller vote of confidence in the ability to set up non-individuated systems, or in the importance of a Number 10 Delivery Unit. This FT piece is a decent summary of the vaccination programme's current challenges.
Hunt the workforce
You can announce all the extra resources you like, but you do actually need extra staff to do a 30% increase in activity. Former Health But Social Care Secretary and Commons Select Committee chair Jeremy Hunt MP formalised his thoughts about the priority issue of NHS workforce shortages into this Financial Times piece.
Mr Hunt’s ongoing meta-inquiry into ‘which idiot was Secretary of State For Health for the longest period ever round here anyway, eh?’ really is quite the thing, as an NHS doctor discusses in some detail.
Towards more Matt Hancock
Last week, I discussed the PM’s wife Carrie Johnson’s friend Nimco Ali and her role in the UN-announced, and promptly un-announced, comeback for Matt ‘Alan’ Hancock.
Ms Ali’s friendship with Mrs Johnson hit the news again this week, as it was revealed by the Mirror that Ms Ali stayed with the Johnsons at Christmas last year, in direct contravention of the Government’s Covid19 regulations.
The excuse subsequently emerged that Ms Ali was part of a ‘childcare bubble’: this seems not to have any credibility. The Government’s rules on childcare bubbles prohibit their formation for any non-childcare purpose. It is explicit: “you can only use a childcare bubble for childcare. You cannot use a childcare bubble to mix with another household for other reasons”.
It’s the Cummings Barnards Castle ‘rules are for other people’ thing all over again.
Covid19 update
You’d have thought that in the wake of the joint select committee report featured last week, the Government would be wanting to check in with its scientific advisors a fair bit given the rising infections and hospitalisations, wouldn't you?
You’d be wrong, as the i’s Jane Merrick reveals: “SAGE had convened once a week since the pandemic started in spring 2020, but in June this was dropped to fortnightly and since July has been monthly, with no meeting at all in August”.
The creaking system
Shaun Lintern is one of the smartest journalists writing about the NHS. He has been a consistent champion of patient safety for long years now, and so it is well worth reading and taking seriously his latest long read for The Independent.
This is echoed in Coventry and Warwickshire ICS chair, Royal Free NED and erstwhile Kings Fund chief executive Professor Chris Ham’s latest piece for the BMJ.
The Care Quality Commission’s latest State Of Care report particularly emphasises the problems of adult social care provision: bad in and of itself, and of course bad in the consequent difficulties of timely hospital discharges.
Matters are so bad that Adam Briggs has brought back his essential weekly Covid19 Tracker.
The Institute for Government’s latest ‘Performance Tracker’ survey for 2021 outlines not just NHS performance, but looks across the public sector. It is a bracing read. The CQC’s adult inpatient survey is a good companion read, which documents the fact that staff have been making good efforts to provide adequate care.
‘Clapped Out: Is The NHS Broken?’, Channel Four’s ‘Dispatches’ programme this week, highlighted the problems with insufficient and outdated diagnostic scanners in the NHS. The Guardian’s coverage reported that “according to data obtained through FOI requests by Channel 4’s Dispatches programme, 27.1% of trusts in NHS England have at least one computerised tomography (CT) scanner that is 10 years old or more, while 34.5% have at least one magnetic resonance imaging (MRI) scanner in the same category. These are used to diagnose various conditions including cancer, stroke and heart disease, detect damage to bones and internal organs, or guide further treatment.
“An NHS England report published last year recommended that all imaging equipment aged 10 years or older be replaced. Software upgrades may not be possible on older equipment, limiting its use, while older CT scanners may require higher radiation doses to deliver the same image”.
And as for the Government’s fictional 40/48 new hospitals programme? HSJ reported that Emma-Jane Houghton, commercial lead on the government’s New Hospitals Programme, told an estates conference there were “limitations” on “capacity and capability” in the construction market, which she described as one of the main risks to the policy.
Chant down Babylon
Babylon Health is a controversy magnet.
Its founder Ali Parsadoust wrote this curious blog on the eve of the NYSE listing (in which it has gone some way short of its self-declared target).
The Parsadoust blog claims , “everything we do at Babylon is focused on sequentially re-engineering every touch point in the healthcare continuum. Michael Porter defined “value” in healthcare as quality of care (patient experience plus clinical outcome), divided by cost of delivery. As our physical world transforms into a digital one, we believe the winners will be those who use accelerating digital capabilities to reimagine the experience of healthcare and overhaul its cost, rather than those who replicate the existing models digitally. So for us, every investment decision comes down to answering a short and simple question: Does it make it better ‘value’?”
This is an intriguing question, coming as it does from a company which has used high-placed political contacts and threats of litigation to get to where it is today. And particularly from a company which makes greatly exaggerated promotional claims about its products, and fails to fix serious problems when notified.
Ali’s blog further claims that “we are creating a world class data infrastructure to deliver a holistic single view of each individual’s health graph, and have platformized our artificial intelligence capabilities to enable them to be quickly embedded across our products”.
The stunning thing is that, given the fact Babylon operates in a highly contestable niche, and one with some considerably more credible candidates, foolish investors and their money are highly likely to soon be parted. (Also, ‘platformized’?)
Cronyvirus and Coronamillions update
We got a fascinating statement from the UK Accreditation Service about the Immensa Health/Dante Labs laboratory, whose mis-testing of PCR samples clearly led to a rise in infections, as I covered here last week. Essentially, it makes it abundantly clear that Innova was not fully accredited.
Dr Duncan Robertson points out that “if true, this is an *absolute scandal*. DHSC, Oct 2020: "It is expected that UKAS accreditation to ISO 15189 or ISO/IEC 17025 will become a mandatory minimum standard by June 2021." (wording later changed). This is down to DHSC's negligence or neglect”.
Laboratory accreditation was being flagged as an issue back in August. And The Guardian reports that “health officials should have known about major failings at a private Covid testing lab within days of the problem arising, rather than taking weeks to shut down operations at the site”.
The Good Law Project successfully got the Information Commissioner to order the Department For Health But Social Care to release the names of the 47 companies in the PPE ‘VIP fast lane’ within 35 days.
Getting the Bill (Health and Social Care)
This week, Parliament resumed sitting on 18 October. The Health Bill Committee next sat at 9.25 am on 19 October.
Other important things
Would appear here.
Recommended and required reading
Nigel Hawkes, former science editor of The Times, has died aged 78. He was a lovely guy, and a fine journalist. This is a good obituary.
The latest YouGov polling on voting intentions confirms some interesting trends.
The Cleveland Clinic's big new London hospital plans to offer doctors significant pay rises for exclusivity on their non-NHS time, according to the FT. This will push wages and thus prices up in the private sector, obviously; probably also indirectly for the NHS.
Timely interview with UCL intensive care professor Hugh Montgomery.
Professor Devi Sridhar’s take on why we must control Covid19 transmission now, or face a winter lockdown