Cowper’s Cut 212: “Only the little people pay taxes”

Notoriously not-tall Chancellor of the Exchequer Rishi 'The Brand' Sunak has spent much of the past week in effect channelling Leona Helmsley's classic line: "only the little people pay taxes". His wife, who is of course relevant under the Ministerial Code, is a £30,000 non- dom for tax purposes on her Infosys fortune shareholding revenue.

Mr Sunak was listed as the beneficiary of trusts set up in the British Virgin Islands and Cayman Islands to help manage the tax and business affairs of Ms Murty’s family interests.

I can only recommend to you Marina Hyde's wonderful summary, but The Nakster has gone yet further since.

He's also been hanging on to a US Green Card, something which the US view quite dimly.

The People's Chancellor has since asked for his family's declarations regarding tax issues to be reviewed by Lord Geidt  (who notoriously let the PM off his wallpaper-funding shenanigans, even after un-shared information came to light).

So, that'll be forensically rigorous.

Brand Sunak also called for 'a really serious leak inquiry' about his wife's tax status, showing that the Chatty Rat leak inquiry has taught him no lessons.

(Purely co-incidentally, has anyone heard from Chatty Chap Michael Gove recently about Government policy? No, me neither.)

At any time whatsoever - but more than ever at this time of a genuine cost-of-living crisis - one cannot easily imagine anything more damaging for a Chancellor than for him and his family to be pretty clearly using tax avoidance strategies.

Yes, maybe the Zeit-Geist may give him an anaemic 'nothing to see here', but this will stick. In Tim Shipman's coverage for the Sunday tijmes, he claims that "Treasury sources are also clear that Sunak actively considered resigning last September when No 10 bounced him into a £12 billion pledge to fund social care reform"

Not just Team The Nakster: The Saj was a non-dom too
Is Team The Nakster alone in their tax-avoiding brouhaha?

Why, no.

No they are not, thank you for asking.

Our very own local hero, Health But Social Care Secretary Sajid 'The Saj' Javid has outed himself as a longtime non-dom, who kept his money in an offshore trust to avoid paying tax.

The Saj's statement in full is here.

You can write Labour's attack lines for them: 'Conservatives: the party of no taxation'; 'Conservatives: all about one nation, except for taxation'.

Taxgate is going to bite this Government like hell, as the effects of inflation hit us all in the bank account.

Oh, and if you need a bit more of The Saj in your life, you may enjoy this bollocks-and-platitudes cocktail of a puff piece that he typed (I'm reluctant to call it 'writing') for Times Red Box.

Health and social care levy will get the NHS back on track

Never in our lifetimes has health and social care felt more important than during the pandemic. It has reinforced our belief in a healthcare system, free at the

The TimesSajid Javid

And how's it going in the NHS?

Erm, it's obviously not going so great.

Whether you prefer the Sunday Times account, or HSJ's sober editorial, there's no escaping the fact that things are in A Really Massive Mess just now. Indeed, they have been so for some months: I know that 'Cut' readers have been paying attention.

The Health Select Committee's new report on cancer services is an unsettling read. "Despite the efforts of NHS England to protect services and encourage patients to come forward, 36,000 fewer people in England and 45,000 fewer in the UK began cancer treatment during the pandemic compared to previous years."

"Neither earlier diagnosis nor additional prompt cancer treatment will be possible without addressing gaps in the cancer workforce and we found little evidence of a serious effort to do this. While our independent Expert Panel acknowledged the short-term progress made, rating progress against 2021 workforce targets as ‘Good’, they rated the appropriateness of these targets as ‘Inadequate’ because they are insufficient to address ongoing workforce shortages".

"On the basis of evidence supplied by the Government and the NHS, we do not believe the NHS is on track to meet the 75% early diagnosis ambition set by the Government. Our independent Expert Panel has also rated the Government’s progress against this target as ‘Inadequate’. The latest data shows that the proportion of people being diagnosed at stages 1 and 2 has been static for several years at around 54%".

Then there is the confirmation that since 2015, the number of GPs has fallen every year. Pulse reports that GPs will get £7.46 per patient to introduce the new extended hours access, which I understand is a 2p per patient increase on the current scheme.

Acute pain

HSJ reported that average ambulance waits in one region have reached two hours for heart attack and stroke patients. The Guardian reported major issues with surging emergency demand in Yorkshire this week, but in truth, it's almost everywhere now.

NHS under ‘enormous strain’ in England as trusts declare critical incidents

Health leaders say heavy demand, staff shortages and Covid cases are overwhelming the NHS

The GuardianAndrew Gregory

Rumours about the ambulance sector potentially facing its own impending 'Ockenden Report' about quality and safety don't seem outlandish (and of course, lack of handover capacity is rarely ambulance trusts' fault).

Oh, and NHSE's publication of weekly winter sitreps has now ended, because 'winter is over' (ahem).

Covid19: like the poor, still with us

The one remaining reliable national survey by the ONS shows that 1 in 13 people have Covid19, according to their latest data.

The level of people in hospital with Covid (over 20,000) is having obvious effects on efforts to start addressing the backlog.

Covid has very much not gone away (I'm writing this issue of 'Cut' while still positive: apologies that it's a bit later than normal).

NHS Confed's boss Matthew Taylor continues his outspoken streak, warning that “the brutal reality for staff and patients is that this Easter in the NHS is as bad as any winter. But instead of the understanding and support NHS staff received during 2020 and 2021, we have a government that seems to want to wash its hands of responsibility for what is occurring in plain sight in local services up and down the country.

“No 10 has seemingly abandoned any interest in Covid whatsoever. The Treasury has taken bites out of the already very tight NHS budget, while soaring inflation means the NHS settlement is now worth less. It is now unclear that anyone in the centre of government feels the unfolding NHS crisis is their responsibility

"NHS leaders and their teams feel abandoned by the Government, and they deserve better".

Matthew is, again, Not Wrong here.

Equally, he knows that the Government is not going to do anything: he's still got to say it. Herd immunity is very much back on the table.

A pension to die for

All this mess makes the publication of the BMA's new pensions retirement calculator for senior NHS staff even more disturbingly timely. Read this thread by BMA pensions expert Dr Tony Goldstone to get a full picture of the fiscal jeopardy that senior staff potentially face by doing extra work, or even remaining employed by the NHS.

I make no apology for repeating myself, and I've been saying this for some years now. This has got to be fixed.

Economic reality with Mackey

Sir Jim Mackey is noted for his forthrightness, and his statements at the HSJ Provider Summit last week that the proposed CIP financial savings for trusts are "probably aren't really possible" was a welcome assertion of reality in the fantasy-prone world of finances.

The Treasury Munchkins will hate him for it, which won't bother Sir Jim at all.

The quote in full: “a 5 per cent CIP [cost improvement programme] probably isn’t really possible, but 1 per cent was also too low. So, we have got to find the reasonable point so we can get back on the bike and get back in shape… But it will hurt.”

Sign of the lese-majeste times
In an interesting move, The Christie is refusing to bow to NHS England's regional office lead Amanda Doyle's instructions to apologise for its conduct over the whistleblowing scandal, HSJ's Lawrence Dunhill reports.

The Christie obviously doesn't feel as if it's going to need a bung from NHSE any time soon. Furthermore, its leadership team might just be remembering what foundation trust status is about: an interesting vibe as we move towards system working. FTs gonna FT?

HSJ's Jack Serle spotted that the management consultancies are cashing in again on the NHSE merry-go-round. After McKinseys got £600,000 for recommending merger of NHS Kiss, NHS Digital and & HEE into NHSE (a mega-merger which,  in reality, the Treasury drove - having been frustrated by Sir Simon Stevens' successfully offshoring blame to those bodies as outwith his control), NHSE is now bringing in PA Consulting in a £2 million deal for help delivering that merger.

NHS mergers always work very well: I bet PA Consulting have overseen loads ...

Oh, and speaking of NHS Kiss, it was a delight to learn this week that their ability to award some funding for small community projects had to be put on hold because of ... purdah.

Purdah has not started. "For UK and devolved government departments the pre-election period for local elections is not fixed to any particular date. The general convention is that special care should be taken in the three weeks preceding the elections. In 2022, that will be 14 April to 5 May."

Getting the Bill

The next stage for the Health Bill is 'consideration of amendments'. No date is yet set.

Procurement rules

Procurement expert Rob Knott has spotted another pertinent pre-procurement notice. This one looks very much one for Palantir to win (COI declaration: I recently joined Palantir's advisory board, and may do some communications work with them).

The Times, they are a-Ai-ing

You may have seen last week's Times AI story, about the potential of pattern recognition software and data mining to help hispitals predict demand for A&E services. This is the Faculty / Palantir tech, used extensively during the pandemic, drawing on the NHS Datastore and other digital initiatives, to help smooth demand as much as possible.

It's worth reading Croydon Health Services' deputy COO Huw Edwards' review of this tech, from a front-line perspective.

He is ... not utterly convinced, shall we say.

Bollocks of the week

NHS is not ‘religion’ & piling in billions is not a cure - it needs surgery

WHAT do NHS diversity managers do all day for their £40,000 salaries? Are “equalities chiefs” actually worth their bloated £90,387 a year? Why isn’t that money spent on doctors and nurses instead? …

The SunTrevor Kavanagh

There was a game bid from the Telegraph for this bolus of concentrated stupidity, but right-wing goblin Trevor Kavanagh's piece for The Sun about the NHS's outrageous outrageousness is a classic of the genre.

Apparently, there are people earning £40,000 a year dealing with diversity in a public service that has a bit of a clear racism problem. Whyohwhy?

Kavanagh goes on to blame the NHS for the waste of Test And Trace (which of course was not the NHS, but in effect a DHBSC/cross-Government non-departmental public body); and of PPE procurement (DHBCSC and the Cabinet Office). It really is that well-informed and researched.

Oh, and apparently the NHS is not a religion. Thanks for that, Trevor.

The Alan comeback

It's a sad and lonely week in which we don't hear from The People's Partridge - our king across the water - in his self-rehabilitation odyssey.

So thank goodness for his latest 'What's The Story, Blockchain Tory?' endeavour to put the entire country on the blockchain.

LOVE the dramatic fire burning in the background. I'm sure we're all well up for investing our life savings in HanCoin! What could conceivably go wrong? A free non-fungible token of Alan for every investor!

Recommended and required reading

Professor Sir Michael Marmot's Guardian Comment piece is a vital and damning read.

Studying health inequalities has been my life’s work. What’s about to happen in the UK is unprecedented | Michael Marmot

Poverty is literally a matter of life and death for those on the margins, and the government has so far failed to step in, says Michael Marmot, director of the UCL Institute of Health Equity

The GuardianMichael Marmot

Open letters are usually extremely 'meh', but Bromley-By-Bow primary care pioneer Sir Sam Everington's in HSJ is not

Ben Goldacre and colleagues' review of healthcare data research and analysis usage for the Government is a thorough piece of work

The Sunday Times has good coverage of the downfall and restructuring of data analytics firm Sensyne Health, whose shareholders (including 11 NHS trusts) now take all the pain