Cowper's Cut 226: Mad dogs and Englishmen go out in the Tory leadership race

The Conservative And Unionist Party's leadership race started out with strong "the Chinese: a great bunch of lads!" energy, accelerating promptly into 'untroubled by economic reality' landscape on the Dutch auction of tax policy that I scoped in last week's column.

It is now firmly into 'Chelmsford's Got Talent' territory.

Sajid 'The Saj' Javid didn't even make the first round of voting, failing to attract the mandatory 20 nominations from his fellow MPs. Clearly, he ran a Blockbuster leadership campaign in an age of Netflix.

As for the rest of the candidates, at the time of writing, there was scarcely a single health or social care policy proposed. At his campaign launch, Tom Tugenhadt (who used to be in the military, you know) suggested tight performance management of managers on A&E performance, which is objectively hilarious.

The second round, requiring 30 supporters, saw Health Select Committee chair and longest-serving Health Secretary Jeremy Hunt eliminated. Unsurprisingly, Mr Hunt showed grace in defeat.

Oh, and Alan's endorsing likely front-runner and final two-er Rishi 'The Brand' Sunak. The People's Partridge must have been promised the gig of Minister for Cryptocurrency.

The Brand himself is briefing MPs and journalists that the problems with the NHS are not about resourcing, but about a lack of output targets.

Yes, really. This Times article features claims that Mr Sunak plans "to set out details of his plans for reform of the NHS and other public services during the leadership campaign. He would focus on the need to hold them accountable for results, not to simply boast about spending".

The erstwhile Chancellor reportedly "told MPs during meetings this week that the trajectory of health spending was “not sustainable”, given it would reach 44 per cent of day-to-day government spending in 2024, up from 27 per cent in 2000. It is understood that he does not propose to cut health spending but to hold the NHS more firmly to account for its budget".

The piece says that "new output targets are likely to be proposed". Ah yes: new output targets, when the system can't come close to meeting existing ones. That always works.

The Brand's diagnosis that the NHS's current problems are about not being held to financial account and its lack of output targets is ... niche.

Oh, and Penny Mordaunt is a fan of homeopathy, and advocated its use in the NHS. Good to know. Homeopathy is based on such concepts as the 'memory of water': the memory of political competence is about all we're left with in this field.

Mass debate

Sunday night's ITV debate saw a remarkable level of mutual loathing on show among the remining candidates, none of whom had anything of any note to say about the NHS or public services. Liz Truss' rather obvious Botox was evidence that she's not averse to a few insertions.

All talked about being "honest" and "straight", as if they had not (save Tom Tugenhadt, who apparently served in the army, and thinks that bringing them in will solve the NHS's waiting time woes) chosen to serve in the administration of Boris Johnson: an obvious, notorious and serial liar whose relationship to the truth goes far beyond the socially distanced.

Towards a health but social care manifesto

You remember the vogue for every representative organisation in health but social care to write 'manifestos' for the main Westminster parties to sign up to pre-General Elections?

Masterpieces of wasted effort lobbying, to be sure. So clearly what the Conservative And Unionist Party's leadership race needs is an updated version with which candidates can align as the field narrows. Here goes.

No further Covid19 restrictions of any kind to be introduced again, under any circumstances. Ever. Herd immunity for the win. We have to learn to live, get infected, suffer long Covid and die with the virus as part of building back better.

A ban on all health but social care wokery such as infection control measures. It is your patriotic duty to be infected. Just buy more Union Jacks.

Departmental spending to be cut by 75% to enable tax cuts presided over by Prime Ministerial candidates with highly questionable tax affairs.

Schrodinger's GPs to be rolled out at scale and pace: simultaneously online-first and digital-only, and also providing same-day face-to-face appointments for everybody, particularly infectious Covid19 patients who want paracetamol.

Legislation to be rushed through Parliament to make the NHS backlog illegal. NHS data analysts to be deported to Rwanda under a 'hostile environment' policy. A new crackdown on health tourism to be overseen by the NHS data analysts deported to Rwanda, working remotely (which is banned).

Efficiency savings from introducing an AI front door to all NHS services to be used to fund 400,000 new hospitals by 2030.

All payments to staff and suppliers to be moved to cryptocurrency via the blockchain.

AI also to be used to bring back matron, via animatronic replicas of Hattie Jacques in 'Carry On Nurse' in all health but care settings.

Did I miss anything?

'Call me an ambulance!' 'You're an ambulance'

A national report leaked to Shaun Lintern of the Sunday Times on Tuesday set out the crisis facing ambulance services in stark terms. HSJ reporting confirmed that the situation is dire nationally.

This is symptomatic of the NHS crisis. The Government does not have the slightest clue what to do about it.

Readers will remember that a month ago, at NHS ConfedExpo, I asked Sajid Javid (then still Secretary Of State For Health But Social Care) what he believed were the root causes of dire A&E and ambulance performance, and how he would use his new statutory powers to address them.

The Saj blamed Covid19: “the root cause is linked to the pandemic - those who stayed away, and that's understandable. Also, there's been the pandemic impact on social care and and that has an impact on flow through in the system, so many hospitals struggle with delayed discharges".

Ahem. Blaming Covid19 is nonsense, as most informed observers promptly pointed out: the Royal College of Emergency Medicine's response was particularly to the point.

Data analyst Steve Black's point was also good:

So, would there be a pointless non-solution announced?

Oh yes.

UK heatwave: England on amber alert as health secretary pledges extra hours for ambulance crews during extreme heat

Britain is bracing for significant disruption as temperatures could soar as high as 40C by Tuesday, while health officials warn of the dangers of extreme heat.

SkySky

Secretary Of State for The Time Being Steve 'The Banker' Barclay announced that there will be extra working hours and more call handlers put in place from Monday and Tuesday.

Sigh.

It is an accurate testament to the quality of too much of our journalism that none of the Conservative leadership candidates has yet been meaningfully pressed on their plans for the NHS and the public sector overall, in the light of their declared passion for tax cuts.

Taking an Uregnt Question on ambulance performance, junior minister Maria Caulfield unleashed her inner idiot with glee, telling the Commons "I don't want to bring politics into health, because I think it's too important".

Yes, she actually said that out loud, in the real world. "I don't want to bring politics into health". Riiiiiight. This is one of the team of politicians responsible for the NHS, who proposed and voted for the new Act that extends political power over the NHS.

Waits and measures

NHS performance continues to slide yet further into the mire.

The waiting list rose by another 100,000 to 6.6 million. The Nuffield Trust's QualityWatch summary of overall performance is a thorough if dispiriting read.

As ever, Rob Findlay's summary is on point: elective activity rose, but demand rose by more.

Picker Institute chief executive Chris Graham pointed to the absolutely horrible and absolutely unsurprising results of the GP patient survey.

And the latest ONS Covid19 infection survey data shows that just under 3 million people had tested positive in the past week: a huge increase from last week's 1 in 15 to to 1 in 19 of the English population.

Ooops.

Re-open the Nightingales

New analysis from the Health Foundation's impressive REAL Centre predicts that by the end of the decade, NHS demand will require an extra 23,000 to 39,000 beds (in 2030/31) to deliver 2018/19 rates of care.

The authors point out that "over the past 30 years, hospital bed capacity in England has more than halved, leaving the NHS with one of the lowest rates of hospital beds per person among OECD countries. This reduction was permitted by shifting some services out of hospital (especially mental health) but also by making efficiency gains in hospital settings".

And NHS England's tradition of writing highly effective letters to deal "immediately" with the A&E ambulances crisis continues, with this beauty.

Arguments over whether 'corridor care' is a valid way to deal with the massive problem of ambulance handovers also surfaced in HSJ.

Surely the solution to both of these problems is simple: a quick trip to IKEA to buy the beds, and then re-open the Nightingales, expanding the concept at scale and pace into hospital car parks across the nation?

What could conceivably go wrong?

"Efficiency, efficiency, at which we can't be matched"

Efficiency savings assumptions are starting to become ever more ridiculous as we amble through the financial year. A trend to watch.

Will the private sector help bust the NHS backlog?

This interesting HSJ piece describes how the former Circle Hospital Bath - now renamed the Sulis, and bought by Royal United Hospitals Bath FT back in 2021 - has been largely successfully integrated by UHB as an off-site surgical centre for lower-complexity care.

UHB sound as if they've got a lot of thing right: staff at each organisation can train at the other; they haven't gone governance-mad; and they haven't alienated the largely UHB-employed Sulis consultant workforce by encroaching on their private practice (which, pre-takeover, was Obviously A Lot).

Since the hospital’s takeover by UHB, Sulis’ private activity increased from 33 per cent in 2019-20 to 40 per cent in 2021-22. But UHB now think the private proportion may shrink back, as they focus more on eliminating 78-week waiters by the end of April 2023.

This resonates interestingly with a new report from private sector information specialists Laing Buisson on the London private hospitals market, which speculates that it may be over-crowded.

The report's promotional material points out that new arrivals and growth have increased the market's size: "with major new entrants from overseas, including Germany’s Schoen Clinic and the United States-based Cleveland Clinic, as well as Nuffield Health’s new London hospital at St. Bartholomew’s, hospital operators are putting large bets on the growth and prosperity of the Central London healthcare market".

Ted Townsend's analysis concludes that:

• Central London’s independent hospitals have seen a resurgence in demand since Covid has faded. But pent-up demand has not flowed into the market as rapidly as optimists in the sector had hoped, with Private Medical Insurance (PMI) and embassy patients still below pre-Covid levels, even though self-pay has boomed.
• NHS PPUs (also covered in the report) haven’t quite returned to pre-Covid levels, as they are still trying to regain access to the facilities needed to treat private patients.
• Revenue for those Central London hospitals, clinics and diagnostic centres which accept private patients is projected to reach £1.9 billion in 2022 (up 6.4% on 2021).

Another HSJ story about the private sector suggested that unspecified "commercial barriers" prevented Herts and West Essex ICS from buying the 'One Hatfield' private hospital. People informed about this suggest that the "commercial barriers" in question are the obvious ones of proprietorial greed and NHS unwillingness to over-pay: the owners wanted a price above valuation (and even at valuation, it was considered too expensive).

A compounding issue is that, due to an East Of England region-specific approach, there is no available capital for a direct purchase; nor any capital-to-revenue-type scheme that would be likely to prove anything other than a set of expensive handcuffs.

Bullish talk on strikes from the BMA

The BMA's new chair Professor Philip Banfield told The Guardian that doctors' strikes are now "inevitable", predicting that they will happen in Spring 2023.

The BMA is claiming a 305 increase in doctors' salaries over the next five years. Professor Banfield added that junior doctors want the 30% increase to be “immediate” and not phased in over the next five years. He said, “doctors are angry, frustrated and feeling undervalued. There is very, very serious discontent [about pay]. After 14 years are doctors worth 30% less? No. I mean, if anything they are worth 30% more.

“It’s almost inevitable that the path taken by whatever government happens next will lead us into direct collision with them. Why are we doing it? If you don’t have doctors, you don’t have the NHS.”

Professor Banfield also announced that he would talk to other trades unions about co-ordinating industrial action.

The Financial Times reported that a 5% pay rise is likely to be offered this week, but cautioned  that "The Treasury is insisting this must come from existing budgets for 2022-23, set last autumn".

So there will be no extra Euros to cover this. Given that ISCs are all meant to make a 1% undersend on their overall budgets, and the Government's 2022-23 Mandate's requirement for efficiency savings of 2.2%, one wonders what is going to have to be cut to fund this.

Cronyvirus and coronamillions update

UK has missed chances to prepare for future pandemics, says ex-vaccines tsar

Kate Bingham suggests lessons not learned about need for scientific and commercial expertise in government

The GuardianNicola Davis

If you're going to make an intervention, best not do it by half-measures.

That seems to be former Vaccines Taskforce boss Dame Kate Bingham's philosophy, judging by this exclusive interview with The Guardian's science correspondent Nicola Davis.

Dame Kate "praised quick government decision-making during her time leading the taskforce, as well as Boris Johnson’s willingness to put money into the vaccines upfront. But she said there had since been missed opportunities – including failing to bring scientific and commercial expertise into the government, and not pursuing the creation of bulk antibody-manufacturing capabilities in the UK".

For bulk-scale manufacturing of antibodies, Dame Kate stated that it was necessary to have bio-processors with capacity of up to 20,000 litres, noting that such processors could also be used for other biological products, including vaccines, and would allow the UK to export.

“We’re way off that [capacity]. So all our biological therapeutics are all imported,” she said, saying the cause was “just lack of Government appetite”.

Bingham added that she would not go back to that role if asked: "the answer is no, because they (the Government) should have recruited somebody in-house to deal with it. They shouldn’t be scrambling for people on the outside to come in and help".

She also evinced surprise that six of the seven vaccines that the Government ordered on her team's recommendations had both worked clinically and been approved for use: only Novavax has not. Bingham stressed the importance of moving away from needle-based vaccines due to delivery cost: “whether it’s patches, sprays, pills, implants, whatever they may be, I think we’ve got to go there”.

Pandemic records at risk as ministers govern by WhatsApp

Official government advice was sent to health ministers by WhatsApp and private email, posing a risk that key information about how the pandemic was handled has

The TimesGeorge Greenwood

The Information Commissioner's Office has launched unprecedented regulatory action against the Department for Health But Social Care for its failures to ensure due record keeping of ministerial actions and decisions during the pandemic.

The less-than-unobtrusive use of private email accounts and WhatsApp accounts by The People's Partridge and his ministerial colleagues will now come under greater scrutiny. 'Cut' has previously covered Lord Bethell's frequent and implausible repeated changes of story about why he could not access his old WhatsApp messages.

The DHBSC is, as The Times notes, already pursuing legal action against the ICO to avoid disclosing correspondence between Alan and his lover, comms advisor and DHBSC board appointee Gina Coladangelo.

They will lose, of course, but waste yet more of our tax in the process.

Recommended and required reading

Working with Nigel Edwards and the Nuffield Trust (thanks to sponsorship from Allocate Software, for whom I do some consultancy work), I helped to write a new long read piece on staff stress and burnout. 'Fronting Up To The Problem: What Can Be Done To Improve NHS Staff Wellbeing?' is worth a read, even if only to remind ourselves of a huge and unsolved problem.

Financial Times article about effective weight loss drug Wegovy