Cowper's Cut 224: We are all '40 new hospitals' now

Sometimes, you just have to laugh.

It isn't even optional. You don't even want to: you're too tired - but it's going to come out anyway.

A wry smile is going to play around the corners of your well-chiselled features, whether you like it or not.

So, as we head towards the remarkable political volte-face at the next General Election of a Conservative government being driven out of office by the tanking of the UK economy, our current Government's blatant untruths about '40 new hospitals' have - with a degree of belatedness to which the word 'epic' scarcely begins to do justice - started to receive some actual sceptical attention in the national media, and beyond.

The National Audit Office announced that it intends to do a full value for money review into these clearly not-going-to-happen '40 new hospitals'.

This, ahem, 'news' comes to us at a time when it has for some years been entirely clear that there aren't going to be 40 of them, and they're not going to be new hospitals. Apart from those minor details, the Government's '40 new hospitals' claim is golden.

This NAO VFM review into something that is blatantly not going to exist will report in 2023. That'll be nice.

I have undoubtedly risked boring 'Cut' readers (and/or those brave or foolish enough to follow me on social media) with my repeated insistence on the utter speciousness of this lie. I'd have bored myself with it, if I were that way inclined.

So it goes. Somebody's got to do it.

And for a long old time, almost nobody else did. A hugely honourable exemption to this criticism goes to my erstwhile colleagues at Health Service Journal, whose coverage of the subject has been consistent, detailed, exemplary and essential. They had the news of the NAO review a month ago.

"Now is the Summer Of Our Discontent ..."

The likelihood of NHS industrial action on pay was not decreased by remarks from a Treasury official reported in the Financial Times this week.

A spokesman for Chancellor Rishi 'The Brand' Sunak suggested that in a recent Cabinet awayday, Mr Sunak had highlighted the Government’s choice to avoid any action that would “feed into inflationary pressures, or reduce the government’s ability to lower taxes in the future”.

Ahem.

As the FT notes, "the Department of Health and Social Care told the NHS pay review body it could afford a headline pay award of up to 3 per cent. Each 1 percentage point increase in pay for the hospital and community health services workforce would cost £900mn — equivalent to the salaries of 16,000 full-time nurses — and would therefore make it harder to tackle treatment backlogs in elective care".

With inflation running close to 10%, a 3% offer to NHS staff would be ... well, courageous.

An un-named aide told the paper that the independent pay review bodies were expected to recommend pay rises typically of “one or two percentage points” above the 3 per cent cap, implying awards of 5 per cent in at least some cases. If ministers accept those recommendations, “unless things change then those rises would still have to come from efficiencies rather than the Treasury handing over more funding”, added the aide.

Interestingly, new research from Ipsos MORI suggests that half of a sample of the population currently (i.e. pre-industrial action) claim that they would support striking NHS staff. 30% say they would oppose it.

Workforce

So, how's NHS recruitment and retention going?

I'm glad you asked:

The signs are getting seriously ugly on workforce retention, as NHS data interrogator George Donald pointed out.

The Times reported that the latest NHS Digital data shows that the number of GPs in England is down to the lowest level since records began seven years ago: "there are 27,627 fully qualified full-time GPs in England, down from more than 28,000 this time last year and almost 2,000 fewer than in 2015". The English NHS has 1,737 fewer fully-qualified fullt-time equivalent GPs since September 2015. An exclusive Pulse survey of 400 GP partners from February found that almost 20% of GP roles were vacant.

Sunday Timeser Shaun Lintern looked at the numbers in midwifery:

Meanwhile , HSJ got a leak of the national elective activity data, and to the surrise of absolutely nobody who's been paying attention, it is some way off the trend required to make the inroads into the 6.5 million-long backlog required. Activity remains below the pre-Covid levels, averaging 88%, whereas the stated aim/ambition/goal was to get it up to 130% of that level.

Ooops.

Covid infections with the 4/5 variants of Omicron are causing some of these problems, both with infections to patients and to staff. Infections continue to roar away, even as the Covid dashboard now moves to only being updated weekly. The ONS announced their plans for the future of the COVID19 Infection Survey, "which include moving to a more flexible approach for our participants whilst maintaining the “gold-standard” data recognised internationally".

And as ever, what you don't measure, you can't manage.

HSJ's editor Alastair McLellan has a clear-eyed look at the various options, none of which are hugely attractive.

It was unsurprising to see one of the Sunday Times business writers tipping Shire Healthcare shares as a must-buy.

ARMed and ready

The BMA's Annual Representative Meeting is always bound to generate some headlines, and this year's was not deficicent in that respect. The ARM's endorsement for a 30% pay rise to avoid strike action will make for an interesting medical contribution to the Summer Of Discontent.

Shaun Lintern's Sunday Times summary of where the BMA is currently at politically is a handy summary, highlighting the importance of the Doctors Vote / Broad Left grouping(s) on the increasingly activist stance of the trades union.

Revealed: Leaked email from GPC chair casts doubt on BMA attempts to address sexism

The GPC England chair was described as ‘naughty’ and ‘petulant’ in emails from within the BMA, casting doubt on BMA culture progress.

Pulse TodayJaimie Kaffash

Meanwhile, Pulse reported on the latest skirmishes in the BMA's ongoing internal culture wars, with GP Committee chair Dr Farah Jameel descibed as "naughty" and "petulant" in leaked emails. This follows their reporting that BMA-funded lawyers are representing  members of the BMA's GP committee for England. These complaints against GPC England members, Pulse reported, "have been made by staff and other committee members, often related to the conduct on the listserver (the email group used by GPC members), and specifically around elections to officer roles within GPC".

Waiting

The unsurprising media spin put on the announcement that long waiters are to be offered elective care non-locally (and accommodation costs) if they are willing to travel was indicative of how poorly the current system leadership understands the root causes of very long waits for NHS care.

Of the 6,000 very long waiters to whom it has been offered, 400 expressed interest. That is 6.7%.

It's worth remembering that under the NHS Constitution, patients have a legal right to start treatment within 18 weeks of a GP referral - unless they choose to wait longer or there is a clinical reason for doing so.

The NHS Constitution still applies. This means that "you have the right to access certain services commissioned by NHS bodies within maximum waiting times, or for the NHS to take all reasonable steps to offer you a range of suitable alternative providers if this is not possible. The waiting times are described in the Handbook to the NHS Constitution".

The Birmingham University report highlighted in the Sunday Times piece that I mentioned last week is now out: 'Forecasting the NHS waiting list in England 2022-30' is worth a read.

On the demand side of the leger, it's also worth taking a look at the new Census data (2021) from the ONS. Specifically, "the trend of population ageing has continued, with more people than ever before in the older age groups. Over one-sixth (18.6%, 11.1 million) of the population in 2021 were aged 65 years and over, up from 16.4% (9.2 million) in 2011. The size of the population aged 90 years and over (527,900, 0.9% of the population) has increased since 2011, when 429,017, 0.8%, were aged 90 years and over".

Digital strategy

Following the release of the modestly sensible digital strategy from NHS England recently, the Government published its own.

There is some nonsense from Health But Social Care Secretary Sajid 'The Saj' Javid (albeit mercifully Blockbusters-and-Netflix-free): "I am determined to make this app the front door to NHS services, and this plan shows how we will add an array of new features over the coming years, with new functionality and more value for patients every single month. My vision is one in which the app is an assistant in your pocket".

Every single bit of tech functionality that The Saj talks about is already possible or available. It's wildly unclear why it should take three years to roll it out in the NHS App, as is being proposed.

The Saj also asserts without any argument that "this agenda matters more than it did when this pandemic began". Um, no. It's always mattered, but even under his tech-*heart*ing predecessor Alan, it just didn't happen. The Saj appears not to have asked himself why this was so.

There is some right nonsense on offer. The document promises that "the system will be equipped to prevent people’s health and social care needs from escalating".

Right. They're going to prevent ageing with digital? This I have got to see.

A warrior for the patient

The launch speech from The Saj at the Policy Exchange think-tank was something else again. Again, he chuntered on about Blockbusters and Netflix. Again, it made no sense.

There was more, sadly. He promised that the NHS app would offer a new unvalidated 'heart age' tool, and share users' blood pressure monitoring with the very GPs whose vacancy rate is nearly one in five.

Digital, digital, digital. Blah blah blah.

The Saj even claimed to be "a warrior for the patient". He didn't claim to be an effective warrior, which is as well when you consider the current state of primary care, ambulance services, social care, A&E, waiting times ... and of course his new legislative powers to intervene in the NHS operationally, which he clearly finds about as interesting as he does every other aspect of the job.

Labour's riposte

Wes Streeting's team are evidently getting motoring with this opposition lark.

As well as repackaging the NAO '40 new hospitals' investigation for the Observer splash, Streeting and co's riposte to Mr Javid's tech-ambitious claims was to publish a list of the past promises made in speeches by Conservative Health Secretaries about digital transformation over the past decade; it numbers sixteen.

But social care

Mr Streeting also briefed The Guardian about his plans to introduce a National Care Service (cautiously, and over the duration of several Parliaments). He has asked The Fabian Society to look into ways of doing this.

The Alan comeback

Our hero had this hilariously badly-argued op-ed in The Times about the Government's plans to break the Northern Ireland Protocol. The People's Partridge suggests that the EU were unreasonably enforcing the very same agreement that the Government sold as a triumph.

Alan faces the Government's fundamental dilemma in seeking to backtrack on what was agreed and signed as a binding legal treaty. He either has to out himself as a fool (who did not understand the deal for which he voted) or as a knave (who had no intention of abiding by his word).

Neither seems terribly surprising for The People's Partridge, but neither is a good look. Alan asserted that medicines accessibility for Northern Ireland decided this issue for him.

Ahem. Alan's allegation that the EU is acting unreasonably was promptly called out by attention-payer Mark Dayan of the Nuffield Trust, who points to these recent and significant concessions on the EU's part regarding medicines importation to NI and three other countries. Professor of European Public Health Martin McKee emphasised the accuracy of Dayan's point, and EU law and trade expert Professor Steve Peers pointed to the OJEU entry regarding this. BBC News also covered this back in April, which I missed.

Alan attempts to play the armchair jurist, by referring to the principle of "necessity" for breaking the legal agreement. Actual lawyers (those people who have actual degrees in actual law) are broadly unanimous that "necessity" is an incredibly tenuous and weak defence of the Government's plans to break their own agreement: it is (rightly, they say) little-used in serious litigation.

Amazingly,  this wasn't The People's Partridge's worst article of the week. His Mail piece about what can win the Conservative And Unionist Party (as was) the next General Election is a classic of how not to do political strategy.

Nor is The People's Partridge's Guardian piece advocating not worrying about Covid's resurgence likely to age gracefully.

Career moves

Tim Leunig is the associate professor of economic history at the London School of Economics: he has been on secondment in the Treasury as adavisor to Rishi 'The Brand' Sunak for some time, after a sojourn as an adviser to the Department for Education.

He announced on Twitter that following the end of his fixed-term Treasury contract, he is going to the Department For Health But Social Care for six months, to work on cancer, mental health and other issues.

Recommended and required reading

Axel Heitmueller's paper for the Tony Blair Institute For Global Change, 'The NHS Refounded: Delivering a Health Service Fit for the Future', is the key read for this week.

The Local Government Association commissioned Ipsos Trends & Foresight to write this 'Signals For The Future' report: it has fascinating material on social attitudes, especially on tax / spending; and on mental health.

In this interesting blog, Steve Black has a go at answering his 'Question Of The Week' from last week about what's driving the huge rise in hospital prescribing budgets.

A new paper in The Lancet from Oxford University researchers suggests that NHS contracting out and outsourcing in the NHS in England 2013-20 reduced care quality and may have led to higher avoidable mortality. Its methodology and conclusions have been robustly questioned.

An interesting piece in Tribune on NHS industrial action by nurses.

It's not in any way a 'news story' (as it's badged), but National Data Guardian Dr Nicola Byrne's commentary on the new health data strategy is worth a read.

Aching irony to see this jejeune piece in The Spectator, widely viewed as the in-house magazine of a Conservative And Unionist Party which believes in personal incvome maximisation, seeking to have a go at doctors for, erm, personal income maximisation.