Cowper's Cut 235: Always look on the bright side with Tiz

Although Dr Therese 'Tiz' Coffey has been scarcely a week in the job, she already looks set to exceed the combined genius of Sajid 'The Saj' Javid (who brought us "a Blockbuster service in an age of Netflix") and Steve 'The Banker' Barclay (who added "urgent hackathons" to the mirth pile) for heroic impertinence.

The Financial Times has been leaked a memo from Dr Tiz: this document is a thing of inordinate beauty.

'New Secretary Of State Ways Of Working Preferences' (published on the Department of Health and Social Care’s intranet) orders DHBSC staff to "be positive", and bans the use of the Oxford comma.

One wonders what Dr Coffey's main motivation can be here: crassness, idiocy, or both.

Nor is Dr Tiz even consistent:

It's a good thing that the politician nominally in charge of the NHS (facing such issues as rampant energy price inflation, growing workforce vacancies, clinician burnout, a 6.8 million-long RTT backlog, and a near-£10 billion maintenance backlog) has got her priorities so spot-on.

Dr Tiz is clearly playing this game on Eric Idle Mode: 'Always Look On the Bright Side Of Life' is henceforth the new NHS mantra.

Once this story broke, Team Tiz started briefing The Times' Chris Smyth that Dr Tiz had not read this, and has no views on Oxford commas. It would be hard to imagine a more perfect example of The Streisand Effect.

Only enforced positivity and banning the Oxford comma can save us now.

Has Dr Tiz been stitched up like a kipper over this by her civil servants?

Why yes, of course she has.

It's easy to understand why: the Government's very public dismissal of Treasury permanent secretary Tom Scholar (followed by this disgraceful personal attack by Tory peer Lord Agnew in The Times, who should have known better than to print it.)

Politicians can and will get a rough ride in Government if they annoy or attack civil servants, as Liam 'There's No Money Left' Byrne learned the hard way in 2008 when his bumptious 11-page 'how to deal with me' document was leaked.

Thursday

The Times has been briefed that Dr Tiz will unveil her NHS Winter masterplan to parliament on Thursday: "Thérèse Coffey, the deputy prime minister and health secretary, will outline her plans to steer the NHS through a potentially catastrophic winter".

I'm sure that the whole health policy universe awaits The Coffey Plan with bated breath.

Business as unusual

The 'damned if you do; damned if you don't' dilemma has been alive and well in Skipton House this week, following the death of Queen Elizabeth II.

The poorest kind of right-wing-tabloid-appeasing politics were on show in NHS England's farcical statement issued that the heads of state and associated diplomats coming to attend the funeral must be charged for any NHS services used.

How are these dignitaries supposed to get appointments or access? If they call an ambulance, it may reach them by the time of King Charles III's coronation.

The workforce dilemmas of giving staff the bank holiday off was, likewise, sure to lead to appointment cancellations and rota nightmares. Perhaps 'Her Majesty's funeral' will join Covid19 on the Government's 'plausible-to-the-ill-informed' list of excuses for the huge NHS backlog: you regular reminder that in January 2020 (pre-pandemic), today's 6.8 million RTT backlog already stood at 4.4 million.

There have also been impacts on training, with the cancellation of scheduled exams:

Less cash-rich, more staff-poor

Health Service Journal ran this 'not quite what it seems' story about a cash-rich NHS. The cash-riches here are the artefacts that you'll get when un-spent and un-spendable Covid19 funding increases meet aggressive accounting techniques.

This HSJ analysis, by Henry Anderson and Lawrence Dunhill, shows that "trusts’ balance sheets are in a far stronger position than before the pandemic, with cash levels reaching around £18 billion – three times higher than in March 2020.

"Multiple sources said this will help trusts cope with severe cost pressures, by effectively drawing on cash reserves to fund real spending, while deploying “technical accounting” measures to reduce reported costs and meet their financial targets".

Anderson and Dunhill also note that the National Audit Office "issued a “qualified opinion” to the Department of Health and Social Care accounts in relation to accruals, saying there was a risk of “material misstatement”.

"Sources suggested these “technical accounting” treatments will now be reversed by trusts’ finance teams, by essentially taking the opposite approach by making less prudent estimates of future spending".

You can almost hear the 'think'-tanks of the right and the Spectator, Mail and Boris Johnson Fanzine whirring into action: 'so why is there a huge NHS backlog if there is all this cash?'

Ah - that'll be the workforce shortages discussed in previous columns.

It'll also be the pensions annual allowance/taper tax issues, which the current high inflation is set to exacerbate. October's inflation figure will be used to uprate NHS pensions. This may prompt staff with significant parts of their pension still linked to their final salary (the 1995 scheme - so those over 59) to retire early this financial year, to lock in what could be a big pension increase.

Indeed, some of those same perverse incentives of an artificially 'inflated growth' are there on the 2008 scheme, though to a reduced extent.

Consultants (and those potentially on higher band 8 and executive-level pay) potentially face massive annual allowance tax bills, due to theoretical growth of pensions linked to inflation. This risks incentivising part-time working for those not actually retiring.

The complexity and financial illogic of the scheme pays risks further de-incentivising added work or staying on:

Towards functioning IT

It can't be many weeks until Dr Tiz joins all of the other recent Secretaries Of State For Health But Social Care, and gets her digital epiphany. (Yes, it does sound a bit like an endoscopy, but it's of rather less practical use.)

It looks very much as if the back-up infrastructure of NHS IT is seriously unfit for purpose. The Sunday Times' Shaun Lintern picked up on a Lorenzo EPR outage affecting all 19 user trusts.

Meanwhile, the ironically-named Advanced issued an update on their NHS workforce software, suggesting that StaffPlan (written in a coding language released in 1999) may again be available in ... January.

That's January 2023, presumably, but they don't specify.

There's nothing like a proper sense of urgency. And that is nothing like a proper sense of urgency.

And speaking of digital failure, how are Babylon's shares doing on the New York Stock Exchange?

Not so well? You don't say.

PFI deals

Among the consequences of the raging inflation which the Government appears to have no plan to address is an increase in PFI indexed repayments. Ouch.

Politics as usual

It's not ideal to comment on speculative stories, but this one seems highly possible in the briefing-fest in which Team Truss have been indulging themselves.

The Guardian's Denis Campbell reports that the Treasury-led review of the Government's planned anti-obesity strategy could lead to its total cancellation.

The piece notes that PM Truss promised to light a bonfire of obesity rules if she won, telling the Daily Mail in early August, “those taxes are over. Talking about whether or not somebody should buy a two-for-one offer? No. There is definitely enough of that”.

“What people want the government to be doing is delivering good roads, good rail services, making sure there’s broadband, making sure there’s mobile phone coverage, cutting the NHS waiting lists, helping people get a GP appointment. They don’t want the government telling them what to eat”.

The Health Foundation's Adam Briggs offers one of several scathing commentaries on this dim-witted and populist proposal.

NHS crisis? What NHS crisis?

The Independent's Rebecca Thomas continues to track the ongoing performance collapse in A&E and ambulance performance.

She reports that "the number of people waiting over 12 hours from arrival in A&E increased from 172,079 in 14/15 to 976,284 in 21/22.

"This does not include 15,900 reports of patients waiting 72 hours in A&E (the report said) as NHS Digital considered it “unlikely” patients would wait this long".

The Alan comeback: it's back

There are legends, mega-legends, and then there is The People's Partridge.

A lesser man than our Alan might have been downhearted by his support for Tory leadership runner-up Rishi 'The Brand' Sunak leading him straight to the Parliamentary long grass.

But not Alan.

The Sun reveals that The People's Partridge is to take part in the ITV programme 'SAS - Who Dares Wins'. In the small print of the article, you see that the contract hasn't been signed yet, but on Alan's past form, this will go straight into the VIP fast-lane.

The year 2022 may yet turn out to have been worthwhile.

However, it is clearly disrespectful to the memory of HM The Queen for The Sun to be releasing news that will so clearly unleash a tidal wave of national joy, at this sad time of national mourning. The paper should show some respect.

Alan's handy tendencies were once more on display when he and his lover Gina Coladangelo were spotted by the Mail in a DIY superstore in north London. Perhaps Alan will single-handedly build some of the Fictional Forty 'new hospitals'?

Recommended and required reading

Sensible analysis by Professor Devi Sridhar for The Guardian about the causes of the increases in the excess death rate this summer.

The EU's Court Of Auditors concludes that ​​"the EU’s tailor-made centralised system for vaccine procurement succeeded in creating an initially diversified portfolio of vaccine candidates and in procuring sufficient doses of COVID-19 vaccines. However, the EU started procurement later than the UK and the US, and when severe supply shortfalls occurred in the first half of 2021, it became clear that most contracts signed by the European Commission did not include specific provisions to address supply disruptions. The performance of the procurement process was not sufficiently assessed ... the Commission has not yet scrutinised or benchmarked that process to draw lessons for the future, nor does it currently plan to test its pandemic procurement system through stress-tests or simulations".

The 'Positive Professor' Karol Sikora is under investigation by the GMC with regards to evidence Sikora gave in the defence of Professor Justin Stebbing, who was suspended from the UK medical register for nine months.

The FT reports on a new technology that may help restore a sense of feeling to the fingers of people who have had strokes.