Cowper’s Cut 232: Barclay banks on innumeracy; Bingham brands blowhard science superpower spin "bollocks"

A viral moment

At last, we got to see what an "urgent hackathon" looks like.

Come the Surgical Supremacy, I suspect we'll rather miss the charmingly bovine ineptitude of Steve 'The Banker' Barclay. His extraordinary helplessness, when confronted by an angry member of the public this week, was compounded by his promise of "more than 50 new surgical hubs, backed by £1.5 billion of government funding, to help us bust the Covid backlog".

"The Covid backlog" to which The Banker refers is of course only the gap between the 4.4 million backlog in January 2020 before Covid hit, and the current 6.7 million and steadily rising at about 100,000 a month.

The first delight thereafter is this is the number: "more than fifty".

OK, so how many? I mean, you've got to fund, staff and run them all, not to mention having to signpost them within the system , so surely you'll need to know how many there are? And indeed, where?

The cautious reader continues with The Banker's piece, which clarifies that "locations for 16 of these new hubs have been confirmed and existing hubs are being expanded with new facilities. Bids for the remaining hubs will be considered over the coming weeks and months".

In other words, 16 new surgical hubs are planned, which will probably in time exist in defined physical places here in the real world.

The rest are as theoretical as the 40/48 'new' hospitals'.

Johnsonomics

I think we can call this imprecision about the number of new healthcare provision  sites 'Johnsonomics'. It's probably the sole domestic legacy in health and care of a truly incompetent Government.

And Liz 'Surgical' Truss is, as I observed a few weeks back, the 'continuity Johnson' candidate of the Conservative And Unionist Party leadership race.  

The economic crisis

When economist and journalist Duncan Weldon is sceptical that the energy price signal is any longer transferring any useful information, then things have unambiguously gotten Really, Really Quite Bad.

Sky News' economics editor Ed Conway's above Twitter thread is also a vital (if depressing) read. His write-up of the thread is here.

The latest Ipsos Issues Index data is out, and finds that public concern about hospitals/healthcare/NHS has slipped to fourth place, with 20%. Inflation/prices is first, with 54%; followed by economy on 36%.

Ipsos' Keiran Pedley outlines trends of public concern measured by the long-running Issues Index over the past decade:

'NHS/health/hospitals' has consistently led public concerns from mid-2014 to the start of the pandemic.

The last time the money was about to run out

2008 was the last time we faced an economic crisis, which was obviously bound to disrupt NHS funding. I was dipping back into my archive of my reports of the annual conferences of NHS Alliance (then a significant and insurgent influencer in the world of NHS primary care and commissioning, with a heft inversely proportional to its slim resources).

In the mid-to-late 2000s, the NHS was shifting very fast as commissioning started to be promised - if not given - teeth.

The 2008 NHS Alliance event seemed quite consequential, coming as the global financial crisis began to hit - and I think it was consequential.

Delegates heard from Chris Ham, Bruce Keogh, Mark Britnell, David Nicholson, Michael Dixon, Mary Warnock, Ben Page ... I also wrote that year's report with my friend the late Professor Bob Sang, whose contributions to the analysis in the final 'coda' section have aged very well indeed.

So I've put that report online here, for students of NHS political and policy history. It's an unashamedly long read, but I think you may find it's worth reading about how the NHS world seemed 14 years ago, when the last Era Of Money was obviously soon to end.

The recruitment and retention crisis

The NHS's ongoing recruitment and retention crisis (the latter particularly regarding pension terms and conditions on the taper tax and allowances) has begun crossing political and media minds - at very, very long last.

The Times had a competent canter around the pensions issues. Radio 4's 'The Briefing Room' had this contribution.

Meanwhile, economist Jonathan Portes points to new Home Office data showing that of the continued rise in work visas, "about 45% are "skilled worker" visas, and 55% are "health and care" visas: now also open to most workers in social care as well as medium/high skilled jobs in the NHS".

A Nepal-ling plan

And The Sun got the story that the UK government has graciously agreed to deprive Nepal of its trained healthcare staff. Makes you come over all patriotic, doesn't it? Bring me another Union Jack!

However, The Times pointed out that "Nepal is on a recruitment “red list”, drawn up by the World Health Organisation to prevent unethical recruitment from countries with shortages of health workers. Nepal has a health worker to population ratio of 0.67 doctors and nurses per 1,000. The WHO recommends 2.3 per 1,000."

Ooops. Billy Palmer of the Nuffield Trust had these thoughts about the dirty deal:

And the RCN 's Howard Catton these:

Very belated movement on pensions

The Government of the slow-witted has finally seen the light on NHS pensions exceptionalism. The Times' Kat Lay was briefed that https://www.thetimes.co.uk/article/nhs-pension-rules-face-overhaul-exodus-senior-doctors-latest-lcz3pj5zx

Zahawi next?

If we are not to be blessed with Nadine, then there are increasing noises that Chancellor Nadhim Zahawi will be given Health by La Surgical.

It's worth reading about the Chancellor's tax affairs: they are unduly murky.

New ideas

One of the more reasonable of the right-wing think tanks, Policy Exchange, this week put some intellectual fare on the table to seek to influence where the health agenda goes next.

It was somewhat welcomed, but not everyone agreed: Steve Black's response being to the point:

The Grail test could be another cautius cause for medium-to-long term optimism.

La Surgical unravels further

Liz 'Surgical' Truss has long promised to "immediately" abandon the NI increase (the 'NHS and Care Levy'), which raises an extra £13 billion. Yes, that's the NI increase for which she voted just six short months ago. God bless her and all who've sailed in her.

Then, La Surgical told a hustings this week that she would redeploy the £13 billion raised by the tax she promises to cancel from the NHS to social care.

Sigh. I'm not making this shit up. She is in Full Auto-Satire Mode, and she hasn't even been announced as the winner and next PM yet.

Her rival is no better. Rishi 'The Brand' Sunak told Spectator editor Fraser Nelson  that the Covid19 lockdowns had damaged the NHS without any broader Government consideration, saying "we didn’t talk at all about missed [doctor’s] appointments, or the backlog building in the NHS in a massive way. That was never part of it".

This is, as 'Cut' readers scarecly need telling, nonsense. As the Health Foundation's work shows, the NHS backlog was 4.4 million strong in January 2020, before Covid19 hit.

Any Government which was not thinking about this prominently in its pre-Covid calculations cannot hope to be numbered among the competent.

The NHS largely had to stop elective work during the pandemic because the Government repeatedly locked down chaotically and late (remember schools reopening for a day after the first Covid Christmas?); and first re-opened incautiously to infection-promulgating Eat Out To Help Out.

Thanks to one Rishi 'The Brand' Sunak.

This drove increased Covid19 infections that created huge bow-waves of demand on a system that had been run hot for an austere decade.

Eye-rolling stupidity from the Telegraph

Estwhile newspaper and Boris Johnson fanzine the Telegraph carried one of the most stunningly stupid pieces ever to self-identify as political journalism, alleging that chief scientific officer Sir Patrick Vallance "rolled his eyes" to crush dissent.

Eye-rolling is clearly the Kryptonite of right-wing lockdown sceptics. Imagine deliberately admitting, out loud in the real world, to being so empirically shit that your arguments could be defeated by an eye-roll.

Is the nationalist-populist right’s Secret Master Plan to get anyone with a brain to cringe themselves to death?

Or imagine if the chief scientific officer had 'given them such a look'. Opponents might have been turned into pillars of salt on the spot.

And if he were to have tutted ... well, who knows what might have happened?

Myopia Unlimited

Vaccine heroine Dame Kate Bingham has been in the news. She made a rare appearance on social media to decry the insane closing-down of the NHS Registry for clinical trials that the Vaccines Taskforce created.

When the scheme was established, a clause was added to ask volunteers who had enrolled whether they would also agree to take part in medical trials that did not involve Covid research: 94% said they would. “That created an enormously valuable resource for the nation”, Bingham noted this week.

The National Institute for Health and Care Research (NIHR) insisted that volunteers already signed up to a national database of individuals willing to take part in medical research had to go through a complex, three-stage verification process to reapply to stay in the scheme.

Ms Bingham did not stop there, telling Times science editor Tom Whipple that, in the triumphant wake of the Covid19 vaccine commissioning (of which she was in charge) and rollout (of which NHS England was, un-helped by Steve 'The Banker' Barclay's refusal to sign off funding), both the Government and civil servants "take our foot off the gas and focus on something else.

"But none of the vaccines are good enough. They don’t block transmission, they don’t protect for very long. mRNA doesn’t have good durability, the data is pretty clear on that ...

"We need to find a better format, we need better vaccines ... I would be exploring more. I’d be looking at more mix and match. I’d be working with the next generation of vaccines".

Kate Bingham for President!

This was exceeded by her interview with Observer science editor Robin McKie, in which The Dame let off a few more sizeable truth-bombs.

“All this talk about the UK becoming a serious science superpower is bollocks, these people don’t actually care. If you really want to make our clinical research strong, you don’t start dismantling what’s been put in place.”

Ironically, all this came in the week when Moderna issued a lawsuit against Pfizer and BioNTech for patent infringement regarding their Covid19 vaccines.

The performance crisis

I don't know how you want to lose your religion over the ongoing health and care performance crisis. Clearly, there are many options.

John Burn-Murdoch's FT summary is devastating. The Independent reveals how the UK Statistics Authority is forcing NHS England to finally be transparent about stats on those facing very long waits in A&E.

The Spectator's excellent Isabel Hardman debates her considerably less excellent colleague Kate Andrews in this podcast about the crisis. IEA alumnus Kate, bless her, thinks the NHS needs more competition, charmingly unworried by the fact that the two leading and serious  NHS competition proponents, the late Professor Alan Maynard and Birmingham's Lord Simon Stevens, both in time accepted that it essentially doesn't work.

Does anybody recall an NHS sector spokesman called Chris Hopson? I vaguely remember teaching him how to use Twitter. Whatever happened to him, when the NHS could use an effective and outspoken communicator working in its behalf?

The Alan comeback

The People's Partridge graced the airways on Monday's Today Programme, Alan seems to be reinventing himself as a Sunak spinner: he reckons that Rishi 'The Brand' Sunak has been brilliant in pumping money into the NHS.

Alan further asserts that it’s not The Brand's fault there’s been a crisis: one that he (Sunak) is best placed to sort out.

Alan's avatar for the 'Metaverse' (Facebook's crap, doomed update of 'Second Life' for the Crypto Bro generation) generated some column inches this week.

And speaking of Alan's favourite tech disruptor, Babylon shares are now trading below $1, which means that after another week or so, a de-listing from the New York Stock Exchange is imminent. One must have a heart of stone not to laugh at Ali Parsadoust, and all those who funded him without doing even the most cursory research.

Recommended and required reading

It seems that Amazon is setting out to disrupt healthcare yet again, by closing down its telehealth offering and buying a provider, the FT reports.

Novartis is selling off its generic arm, Sandoz.

My 'NHS chief anthropologist' hypothesis was influenced by Gillian Tett, whose latest piece in the FT is a fun investigation of culture wars in US academia.

The New Yorker has this disturbing piece about what happens when private equity buys a nursing home.