Cowper's Cut 243: Steve ‘The Banker’ Barclay unwittingly invokes Moore’s Law in the shadow of the Hunt Budget
![Cowper's Cut 243: Steve ‘The Banker’ Barclay unwittingly invokes Moore’s Law in the shadow of the Hunt Budget](/content/images/size/w960/2022/11/75C96796-6618-4D9F-8E07-6B15D7ACA42B.jpeg)
"Most of all, I am looking forward to being myself.”
Former Health Secretary Matt Hancock MP, on his appearing on 'I'm A Celebrity ... Get Me Out Of Here!'
Chancellor Jeremy Hunt on Matt Hancock MP appearing on 'I'm A Celebrity ... Get Me Out Of Here!'
As surely as day follows night, the NHS's latest RTT backlog list of people awaiting treatment moved up by a further 100,000, to 7.1 million.
There are two things to note here: In 2010. we used to have a target (largely met!) of no more than 2% of attendances >4hrs, and now we’re breaking that level for *12* hour waits. (1/2) https://t.co/7s9lh0rVDy
— Chris Cook (@xtophercook) November 10, 2022
The backlog data is enormously ugly, if not unexpectedly so.
As the Nuffield Trust/Health Foundation QualityWatch analysis points out,
- Emergency care performance continues to deteriorate, with A&E waiting times in October 2022 being the worst on record. 31% of attendees waited over 4 hours before being discharged or admitted.
- A record number of people, over 150,000, waited over 4 hours between a decision to admit them through A&E, and being admitted. A new record was also set for the number waiting over 12 hours.
- The elective care backlog continues to grow beyond 7 million, with month-on-month increases in the waiting list.
- Progress has stalled in reducing the number of people waiting over 18 months to start treatment, meaning the target of eliminating such waits by April is very unlikely to be met.
Ooops
Ooops.
The Daily Mail ran a reasonable piece of analysis of the performance problems. Similarly, The Guardian has this decent piece on delayed discharges to rehab and/or social care.
NHS England's Pollyanna-Micawber correspondent Dame Chris Hopson tried to put as positive a gloss on matter as possible:
Today’s NHS statistics show two things. 1. NHS staff working flat out to deliver best possible care amidst difficult challenges. 2. NHS under significant pressure, particularly urgent care, with intensive work to stabilise and improve services in train. New thread 1/25
— Chris Hopson (@ChrisCEOHopson) November 10, 2022
This didn't really help.
Thursday's Financial Statement is going to throw the blatant absence of any real plan to address the backlog and performance problems into yet sharper relief. That will put the use-value of NHS England back on the top of the agenda.
The data day
NHS performance has been in broader consideration, with the latest ONS analysis looking at Covid19 impacts, as below:
We’ve published insights into England’s health in the early stages of #COVID19 at national, regional and local level.
— Office for National Statistics (ONS) (@ONS) November 9, 2022
England's Health Index declined from 100.5 (2019) to 100.1 (2020), but this decline was not seen in all areas of health.
➡️ https://t.co/irJ3pe36e8 pic.twitter.com/McsepjzgPz
Dr Duncan Robertson presents important data from the latest Independent Sage report in the following Twitter thread:
Today's data slides from today's @IndependentSage briefing.
— Dr Duncan Robertson (@Dr_D_Robertson) November 11, 2022
The pressure on the NHS is severe, both in A&E wait times and ambulance response times.
And all this is during unseasonably warm weather.
First the good news...
🧵 pic.twitter.com/fnLx8oT4Ci
Things really are in quite a bit of a mess.
RCN strike ballot for action
Last week, I described the near-certain media and political pitfalls set to face the nurses' trades unions once their members vote for industrial action, as they indeed have done.
The Government, through its entirely politically impartial Department For Health But Social Care, issued its early salvos, which are predictable.
Nursing expert Professor Alison Leary offers some useful context on them below:
Interesting graph but it doesn't account for inflation (ie what the pay is actually worth) or context of work. Not uncommon for a "band 6" to be in a leadership role or a case manager. Responsible for a large budget, team of staff and 24/7 clinical responsibility for low 30ks https://t.co/I7qNsoRVCM
— Prof Alison Leary 💙#ProtectNurse (@alisonleary1) November 11, 2022
Whether the nurses' leadership can get their communications right will be (as I said last week) the defining issue of this industrial action.
Shadow Health Secretary Wes Streeting: 'If the answer in this century is always more tax payers' money into a 20th century model of care there isn't going to be an NHS in the long term.'@AndrewMarr9 | @wesstreeting pic.twitter.com/iwIa8eQAHP
— LBC (@LBC) November 7, 2022
We shall see. It's certainly worth re-reading Dr Agnes Arnold-Foster's piece for Tribune about nurses' roles in past industrial action.
Hunting the Hunt Budget
"There are massive pressures in the NHS".
— Sophy Ridge on Sunday & The Take (@RidgeOnSunday) November 13, 2022
Chancellor Jeremy Hunt admits doctors and nurses are under "unbearable pressure", adding that we "need the NHS to get us out of the economic challenges that we're in".#Ridge: https://t.co/ZoMhCmTZj3
📺 Sky 501, Virgin 602 pic.twitter.com/lpc1g5b2lp
A few weeks ago, I observed that Chancellor Hunt will have to do most of what he is going to have to do on Thursday using fiscal drag.
This morning the Chancellor has given perhaps his clearest defence yet for his decision to close the “black hole” in the public finances with the expected tax rises and spending cuts in next week’s Autumn Statement.
— Tom Boadle (@TomBoadle) November 11, 2022
Worth watching this key Q&A in full: pic.twitter.com/zV3mBeSOV7
This is less because I am a political genius; and more because most voters do not understand fiscal drag at all. If they've heard the term, they probably reckon that it's what RuPaul spends on shoes, wigs, make-up and costumes.
The Financial Times' Chris Giles and Jim Pickard have this useful piece about the austerity 2.0 briefings so far.
Delightfully, all of the above isn't all of everything we have seen in the weak media econo-political briefings this week.
The Banker's Implication
Re-tread Health But Social Care Secretary Steve 'The Banker' Barclay's not been left out of the media briefing frenzy these past seven days.
The Banker's Implication is that the 40 new hospitals by 2030, fixed in the 2019 manifesto, is wildly unrealistic nonsense. (No, I've no idea whatsoever from where he might have got that idea.)
His Times-briefed piece says that "Barclay is understood to be considering where else he might find savings, with possible options including Sajid Javid’s Office for Health Improvement and Disparities, the UK Health Security Agency and a £4 billion increase in funding for fixing crumbling buildings and improving IT".
[Waves bye-bye to 40 new hospitals. Even the Evening Standard has noticed.]
The Banker's leak and (John) Moore's Law
It's been a long time since such a thing happened, but The Banker's leak to The Sunday Times that he thinks the NHS does not need an increase in funding is not actually original.
It's an example of Moore's Law.
When many of us hear of Moore's Law, we think of the computing processor power original proposed by Gordon Moore, way back in 1965. But The Banker is invoking a different kind of Moore's Law.
John Moore's Law, to be precise.
John Moore was one of the 'smoothies' admired by and appointed to Cabinet by Margaret Thatcher. He is also the last relevant minister to suggest (as The Banker is doing) that the NHS does not need more Euros.
Mr Moore was a strong proponent of actual NHS privatisation, as his Cabinet career reveals. (He was also a more interesting character than you might think, as this piece reveals.)
I say we will have no more money
Economic protestantism is evidently back in the political ascendancy, as the NHS England's HSJ-revealed tight crackdown on spending limits without permission reveals.
Evidently, these spending caps on what can be done without the involvement of the reassuring fiscal genius of NHSE will make every decision a good and wise one.
Ahem.
Our health funding system: the NHS is in financial crisis every year. The response is ~always steep cuts to buildings, IT and public health. These fall further behind other countries - something that cost £billions and 1000s of lives during the pandemic. https://t.co/NsAhDl8U35 pic.twitter.com/dbH6odiuJV
— Mark Dayan (@markgdayan) November 12, 2022
Cronyvirus and Coronamillions update
Following our coverage of last week's Sun revelations that there is a 'Great British Burn-Off' in prospect for the Government's and DHBSC's vastly over-bought PPE, this week the Mirror revealed that "the Government is still spending millions of pounds each week to store 13.2 billion items of unused PPE ...
The Alan comeback
Oh God.
Matt addresses the elephant in the room and answers the big questions dominating camp… #ImACeleb pic.twitter.com/jSA63Ehpgw
— I'm A Celebrity... (@imacelebrity) November 11, 2022
How long have you got?
A teaser clip of Matt Hancock's debut I'm A Celeb Bushtucker Trial shows the MP screeching with comedian Seann Walsh as they sludge through mud and bugs
— ITV News (@itvnews) November 9, 2022
Read more here: https://t.co/mAz4HU6Brz pic.twitter.com/UtJu9we2lg
How long have I got?
"Survival in the jungle is a good metaphor for the world I work in”, The People's Partridge told a grateful nation in one of his promo clips.
Mmmmmm.
If not mmmmmmmmmmmmmmm.
Mr Hancock has written to constituents who have contacted his office about his absence without leave from his MP duties, replying, “there are many ways to do the job of being an MP. Whether I’m in camp for one day or three weeks, there are very few places people will be able to see a politician as they really are and where politicians can speak candidly to the nation".
A-ha.
It's a 'This Is Me' thing for Alan.
I think it's wildly obvious that I don't value Alan's abject barrel-scraping career comeback attempt. I think it's just as evident that I think the bloke is an abject fundament of a human being.
Equally, I can recognise that there is an intrinsic and nasty bullying aspect to the set-up of IACGMOOH. So I'm not watching it.
Bear-baiting was a thing in its time, five hundred years ago.
Bear-baiting isn't how the politics of the early 21st century should deal with its turds and onanists.
Two times now he’s been asked why he’s entered the jungle. Two times he’s failed to mention his dyslexia campaign. #ImACeleb
— Liam O'Dell (@LiamODellUK) November 9, 2022
Not even if the individuals in question happen to be as much of a turd and onanist as Alan - whose advocacy for dyslexic people, which I mentioned last week, has been conspicuously absent from his participation in the broadcast - has proven to be in 'the real world' of The Jungle.
Please be more specific… https://t.co/55wvpZT6q2
— Sajid Javid (@sajidjavid) November 12, 2022
Alan's search for forgiveness
I even stand by the above comment, when seeing that Alan claimed to be doing IACGMOOH not for the £400,000 fee, but for "a bit for forgiveness".
The person whose forgiveness Alan genuinely seeks is his one true love, and that is Alan.
Reality-televised 'forgiveness' won't make any difference anywhere else.
Palantir update
IT firm Palantir (on whose health advisory board I am paid to sit) has been in the media this week. HSJ reports that to help address the big old elective backlog, NHS England is ordering its impending mergee NHS Digital "to use Palantir’s Foundry platform to collect data about patients’ admission, inpatient, discharge and outpatient activity at acute hospitals.
"Identifiable data such as patients’ NHS numbers, date of birth, and postcode will be collected through Palantir’s software. Patients cannot opt out of having their data collected".
Nick Carding's piece adds that "NHS Digital’s Caldicott Guardian – who is meant to safeguard use of data – has identified “risks” in the pilot and said it needs additional work before it can meet confidentiality requirements".
The sharp-eyed Rob Knott spots that:
“This contract has already been awarded [to Palantir] and is being published for transparency purposes”https://t.co/OtwFGyq5KB
— Rob Knott (@Procure4Health) November 13, 2022
From Twitter to Mastodon
Those of you who make it this far: well done!
This is just to let you know that I'm no longer really posting on Twitter, since its acquisition by the fundamentally-unsuitable Elon Musk.
Clearly, as the links here show, I'll still need to read it, but generating free content for a firm run by a buffoon isn't my preferred option.
So I've moved to the decentralised, somewhat clunky new environment of Mastodon, where I can be found as @HPIAndyCowper@Mastodon.online. You sign up to a server - that is the second @ section of your username; thereafter it's reasonably recognisable.
Mastodon is yet to acquire the critical mass to become a significant alternative to Twitter, but it might. Certainly, I'm not alone in having found that the user experience of Twitter has deteriorated over several years now, with inaccurate and interfering algorithms, and lousy-to-no moderation of abuse and harassment: Elon Musk's ownership is likely to further hasten its decline.
Come and say hello, if you get there.
Recommended and required reading
Excellent BMJ piece on how failing IT infrastructure is undermining safe healthcare in the NHS.
The Health Foundation's Adam Briggs has this thoughtful offering for The Banker.
Marina Hyde's Alan put-down is just majestic.
Engage Britain have this decent piece on social care.
We all need a laugh in these bleak times, and the owners of Excel trying to sue their insurers for lost profits while the venue was rented out to be a Nightingale PR stunt, sorry, hospital provides just that.