Cowper's Cut 216: WHO's in the right?

The World Health Organisation's release of estimates for comparative country-by-country data on global excess deaths caused by Covid19 provoked some emerging gloating by members - and former members - of the Government.

The People's Partridge (of whom, inevitably, more below) responded claiming that "once the measurement issues are stripped away, the UK performance was similar to or better than most comparable countries. In the UK, we measured very carefully and published data as accurately as we could".

Ahem ahem, Mr Hancock: biostatisticians will probably argue over these WHO estimates for some time, but let's remember your '100,000 tests for a day' cheating fiasco, which caused the UK Statistics Authority to write to to rebuke you for this.

Just as pertinently, Bristol statistician Oliver Johnson points out the curiosity that this pretext is often used to re-fight the war of the first lockdown, when "autumn and winter 2020-21 ... was the period when more than half of our total pandemic deaths occurred".

There is good news on Covid19: the latest ONS data continues to show a big fall. The 'Easter Effect' that I was fearing did not happen: sometimes, it's great to be wrong (and it's always good to admit it when you are).

Think local, act local

This week's local election results saw the Conservatives lose nearly 500 seats. This is a performance worse than what Tory partisan nonsense-newspaper the Mail defined as a 'disaster' event, but they have since been curiously silent on this disastrous matter.

Perhaps they're just not very good at counting?

The political change is of course more important, with the Health And Care Act's advent of ICSs and the change to political decision-making by local authorities about spending on social care.

The £85,000 lifetime personal spending cap is, of course, not here yet. But this set of elections may make regional disarities in access to adequate social care (and the inevitable consequent impacts on the NHS) move up the agenda.

We shall see.

No more nonsense targets! Possibly

Happy anniversary! It's eight months almost to the day since Health But Social Care Secretary Sajid 'The Saj' Javid promised a review of "nonsense" NHS targets on BBC1's late, unlamented Meh Show, without his being able to name a single one of them. Indeed, without actually being asked what they were.

OK, I know it's been two-thirds of a year, but it really is bound to be an awesome review. It's just ... taking its time to come together. (Those with long and detailed memories may recall that Theresa May set Steve Powis to do a review of NHS targets in 2018: they could always take a look at that?)

What do you mean, you think he just made it up to have something to say on Meh and never meant a word of it? Oh, you cynics, you.

The Saj has been hard at it this week, briefing the Telegraph that he will 'name and shame' NHS trusts that do not comply with the new relaxed guidance on infection control and social distancing.

The People's Saj will apparently phone up trust chief executives to tell them to do what he says: an operational interference made possible by the new Health And Care Bill. (We all know that shouting at people about what to do is NHS England's job, really.)

Things we know won't work

My late friend Bob Sang (the UK's first professor of patient and public involvement in health) had a nice taxonomy of policy proposals. Bob felt they could be listed in quadrants: things we know will work; things we hope will work; things we know won't work and things we hope won't work.

Firmly in the third such quadrant sits the charmingly optimistic request in NHS England's letter 'Enabling The Workforce For Elective Recovery' to "encourage recently retired staff across the workforce to return with contracts that support elective and educational recovery. These colleagues may wish to take up training lists and outpatients, as well as supporting the wider development of the NHS workforce ... (and) encourage individuals considering retirement to return to support and educate the wider elective recovery workforce as the next chapter of their careers".

The main reason why it won't work is because of the first section under 'Nationally led actions' - 'pensions'. While the letter states that NHSE "also continue to work with Government on ways to address concerns about barriers within the NHS Pension Scheme", the fact is that the Treasury Munchkins have dug their adorable little heels all the way on on this one.

The BMA is keeping up its campaign, as are professional accountants.

Pensions tax changes aren't the only reason, though: anecdotal evidence suggests that not a few senior acute staff only got themselves through the pandemic's worst points by promising themselves that this would be it.

These people's inclinations to remain/return might be otherwise, were the pensions taper tax/annual allowance disincentive were not there; or were there were a credible recovery plan and had the returner work led by ex-DH workforce director-general Andrew Foster had been taken seriously (as I wrote about here, last October).

But none of those conditions have been met.

So, the chance that such begging letters to 'come back' or 'stay on' will acheive much is slim.

Round and round the table, like a teddy bear

The Guardian FOI'd the minutes of round-table meetings at 10 Downing Street with digital folks, drug marketeers, GSK and J&J staff to produce this story about proposals for:

"the creation of a new category of what were described as “special forces nurses” to “reward’’ NHS staff who helped speed up testing and trials of new drugs in hospitals. The minutes state: “This would help the industry move away from the current culture/fear of scapegoating if anything goes wrong.”

"Removing barriers preventing startup companies from accessing NHS data. Such firms have traditionally been excluded on account of the risks associated with them.

"creating 'data trusts' – third parties, independent of the NHS and industry – that would hold and allow startup companies access to NHS data, as a way of overcoming concerns about confidentiality and the use of private information.

"a data equivalent of the organ donor scheme, which patients could opt in to, with the result that driving licences might read “data donor” as well as “organ donor”. The minutes described it as an “attractive idea” but added that a Tory MP and taskforce member, George Freeman, had previously championed this and could not find a form the then health secretary, Jeremy Hunt, was comfortable with.

"easing the level of inspection of innovative cell therapy – the introduction of healthy cells into a body to destroy diseased ones – required by the Human Tissue Authority. Critics have expressed concern about reducing regulation and oversight in a relatively new area where ethically sensitive issues have cropped up".

Mmmmmm. If not mmmmmmmmmmmm.

Lard and more lard

Our obesity problem has not magically fixed itself, the WHO reports.

Francisexit

Sir Robert Francis, chair of the Mid-Staffs inquiries, announced his intention to step down both from the Care Quality Commission board as a non-executive director and as chair of Healthwatch England.

In his email to The Saj (shared with Health Service Journal), Sir Robert emphasised that unless the budgetary shortfall of Healthwatch is addressed, "there is a growing risk the network will be unable to fulfil its vital role".

It is inevitably too early to form a meaningful assessment on Healthwatch UK's effectiveness. Sir Robert's measured remarks are unlikely even to register with The Saj, but the issue of patient safety will certainly rise up the media and political agenda as the consequences of the collapse in ambulance service performance become yet clearer and more visible.

HSJ has data shared by the Association of Ambulance Chief Executives suggesting that over 38,000 patients were put at risk of harm by service problems in March 2022, 4,000 of whom at serious risk. This follows on from previous HSJ coverage of the sector's problems.

The Alan comeback: All You Need Is To Love Crypto

The People's Partridge was on great form in this City AM interview, in which he again shills for crypto. Like a fine wine, Alan is improving with age: becoming ever more complex and deep.

The magnificence on show here is dazzling: "“It’s right to say you may lose everything, but you may not right?” said Hancock, adding that he welcomes warnings from the FCA which make investors aware about the risks of investing in crypto.

"Hancock, who does not invest in crypto himself, went on to dub rules restricting access to high risk investment products “patronising.”

"Hancock told City A.M. he has no plans to make a return to the cabinet at present". It's the Cabinet's loss, obviously, but shouldn't this have been their front page splash?

Coronamillions and cronyvirus update

It would be a terrible shame if Conservative peer Baroness Mone and her involvement with National Crime Agency investigation subject (and supplier of unusable PPE) PPE Medpro were to slip our minds, and so it's time to revisit this remarkable email, sent by ex-Test And Trace chief commercial officer and now NHS England commercial director Jacqui Rock.

Ms Rock emailed colleagues on 10 February 2021 to warn them that "Baroness Mone is going to Michael Gove and Matt Hancock today as she is incandescent with rage on the way she believes Medpro have been treating in the matter.

"It would appear that no one has told them that they have failed anything and they are being, in her words, fobbed off with another round of testing which Porton Down are saying they are identifingy sites to set up and don't know when it will be done.

"It does not look like anyone has had the conversation with them or the other supplier to give them the facts. They are not being given the opportunity to fix that".

This sits curiously with Baroness Mone's lawyers' assertions that any suggestion of an association or collusion between the Tory peer and PPE Medpro would be “inaccurate” and that she was not involved in the company. “Baroness Mone is neither an investor, director or shareholder in any way associated with PPE Medpro. She has never had any role or function in PPE Medpro, nor in the process by which contracts were awarded to PPE Medpro.”

Mone’s lawyers told The Guardian that after she undertook the “simple, solitary and brief step” of referring PPE Medpro to the government she did nothing further in respect of the company. Mmmmmmm.

Mone (who, like The People's Partridge, self-identifies as a blockchain / cryptocurrency expert) has been serially unforthcoming about her exact relationship wih PPE Medpro, as this Financial Times piece makes beautifully clear. Nonetheless, the linkages are there to see, as the FT's Kelly and Gross made clear last November.

I suspect that a good deal more is yet to emerge on this.

The Good Law Project's High Court  case against the award of testing contracts to Abingdon Health saw the release of further Government emails this week.

They are really quite something.

Civil servants described the Government’s approach as “unlegit”, and “no way to do business”: an accounting officer wrote of his wider concerns about “how unlegit the entire testing strand is”.

A senior civil servant responsible for the antibody testing team wrote that the preferential treatment being given to Abingdon Health would mean that competitors “might complain”.

Other emails between civil servants reveal they were told by Ministers “don’t bother with HMT and rules, just buy the stuff and we can deal with it later” - and one references “No 10” trying to push through a separate deal that was “dodgy”. The risk summary cites the “lack of clarity on value being delivered against big contracts such as Randox”.

Bollocks of the week

The Daily Mail's death-of-irony 'Where HAVE our GPs gone?' front-page headline feature (following the self-identified newspaper's lengthy anti-GP coverage of the past few years) was a strong contender for BOTW, but this week's runaway winner is Simon Jenkins' so-bad-it's-brilliant NHS-bashing Comment piece for The Guardian.

Even by Mr Jenkins' bathetic standards, the piece is full of wild assertions. He slams "the scandals of PPE procurement" (done by the DHBSC and Cabinet Office - not the NHS); "care home Covid deaths" (the responsibility of the SOS, as last week's Hugh Court ruling found - not the NHS); "epilepsy drug failures" (the role of safety regulators - not the NHS).

Jenkins makes a full paragraph of evident errors, claiming that "relentless centralisation has stripped local authorities of any responsibility for healthcare (the 42 newly-statutory ICSs reverse this). It has also led to ruthless privatisation (no, it didn't). Cash has been carelessly tipped into drug companies (the capped UK PPRS and its voluntary successor scheme give us one of the best-value deals on pharmaceuticals in the world, and our world-first cost-effectiveness assessor body NICE is being copied almost everywhere), IT gimmicks (the NHS Datastore and app were both crucial during the pandemic), management consultancies (use of which was almost entirely mandated and procured by DHBSC/Cabinet Office), offshore privately run care homes (almost all have been private for decades, oh, and do we really have care homes offshore?) and stupefying bureaucracy (the NHS has too little management, not too much)". 0/7: must try harder.

Jenkins also asserts of the NHS that "this corporation is rotten at its centre and fraying at its edges. Its three pillars, hospital trusts, GP partnerships and the care sector, are uncoordinated". Excluding the aforementioned fact that ICSs have been created partly to better co-ordinate co-operation and collaboration across health economies, the unarguable fact remains that the care sector has been almost totally privately provided for decades.

He concludes that the NHS "needs a high-speed bipartisan commission of inquiry – and urgent reform". The right response to any Simon Jenkins comment piece is, naturally, to do the exact opposite of his recommendations.

Recommended and required reading

Nuffield Trust boss Nigel Edwards' Twitter thread in the rise of the political right's unfocused and ill-reasoned attacks on the NHS (which 'Cut' has been tracking) is a superb read

His NT colleague Mark Dayan's sensible analysis of the recent Civitas study on NHS performance (which underweights staffing problems) is equally worth reading.

The Commons Health And Social Care Select Committee published its proposals for reforms to how the NHS compensates victims of medical accidents.