Cowper’s Cut 255: The work of mechanical reproduction in the age of art

"I would love – nothing would give me more pleasure – than to wave a magic wand and have all of you paid lots more."

PM Rishi Sunak, to NHS nurses in North Tees this week

Walter Benjamin's 1935 essay 'The Work Of Art In the Age Of Mechanical Reproduction' proposes that the aura of a work of art derives from its authenticity (or uniqueness), and from its physical and cultural location.

Benjamin said that "even the most perfect reproduction of a work of art is lacking in one element: its presence in time and space, its unique existence at the place where it happens to be".

This piece was on my mind since watching Health But Social Care Steve 'The Banker' Barclay's evidence to the health select committee this week.

I went there in person: it was interesting.

White noise

Barclay has perfected a means of delivery: a vaguely authoritative-sounding burbling about the surface of the policy and politics of health and care, untroubled by any deep understanding of the issues.

It's the political equivalent of the audio term white noise.

It is a - indeed it is the - performance of politics. The old line that 'politics is showbusiness for ugly people' no longer needs those last three words.

Politics has turned itself into performance: look at Matt 'Alan' Hancock's career for proof. The People's Partridge's boundless Dunning-Kruger self-confidence that he is a good communicator and a celebrity brought him to where he is today.

For some years now, I've been writing about the trend of the modern Conservative And Unionist Party to 'comms it': that is, to try to win the political narrative, without being right about the actual issues.

It worked for them, at first. They managed to move from opposition into (*coalition) government with their austerity narrative that the real and root cause of the global financial crisis was the New Labour governments' having 'maxed out the nation's credit card': a large and obvious untruth, as anyone who is not economically illiterate knows.

The Conservative And Unionist Party couldn't have done it without a largely compliant, client, deferential and/or scared media landscape of declining intelligence and impartiality.

But their belief in communications as the ne plus ultra has been the one guiding principle of the Conservatives' past decade-and-a-half: just remember the glory of Andrew Lansley's 2011 statement on his reforms "I'm sorry if what I'm setting out to do hasn't communicated itself".

Ahem.

A lot of fixing the ongoing and not-recent NHS crisis is about technical areas: equipment, estates, processes and skills. All will need deep understanding; expertise; and fierce change management and delivery skills. Attempting to 'comms it' will be impertinent, literally and metaphorically.

To invert Benjamin's title, the next bit of non-firefighting, productive and pertinent NHS reform is going to be the work of mechanical reproduction in the age of art.

We can see the signs of Tory fraying everywhere, divorcing their claims ever further from the reality-based community.

In these circumstances, it is not surprising that there is no meaningful health and care recovery plan. DHBSC permanent secretary Sir Chris Wormald Chris Wormald told the same session of the Commons Health Select Committee that “we are very confident that we in the NHS have a clear plan.”

Ahem. Anyone who’s ever driven a car in ‘limp home’ mode will find the current management and political approach to the NHS very familiar indeed.

"We are engaging with the trades unions"

The People's Steve told the Health Select Committee in his very first answer that "we are engaging with the trades unions", which is an awfully long way from the truth. All of the major trades unions agree on this.

This week is set to see the biggest industrial action in the NHS's history, by some measures. In a functional and normal political system, this would be driving intense pressaure for meaningful negotiations.

The Government clearly feels that there is no such pressure.

Likewise, efforts from NHS England's published evidence to the Pay Review Body are what one might politely call 'not too encouraging', as Health Service Journal's Dave West notes.

Longstanding health policy expert and former ministerial political advisor Tony Hockley's response to this feels accurate and pertinent:

Strike force

59 percent of those people surveyed back strike action by nurses, according to new research by Public First, shared with Politico. The Government's 'wait it out' strategy does not appear to be yielding any results, so far.

Julian Hartley, the impressive former CE of Leeds now in charge of NHS Providers, made his comments on the industrial action. He told The Times, “It’s plain for everyone to see that there need to be meaningful negotiations in relation to pay and there needs to be a rapid resolution.

"If these strikes go on indefinitely, that will have an impact on our ability to get through the elective backlog, to implement all of the planned improvements. The challenge around the industrial action is a big one.”

The Guardian reported this week that the past seven weeks of strikes have caused 88,000 operations to be cancelled.

Hospitals in England cancel 88,000 appointments in seven weeks due to strikes

NHS leaders warn disruption to patients could become even worse as healthcare staff plan further strikes

The GuardianDenis Campbell

And the chief nurses of the Shelford Group of major teaching hospitals issued a statement that "industrial action needs swift resolution ... we want a resolution because of the impact on the patients and communities we serve. Industrial action means appointments cancelled, diagnostics delayed, operations postponed. The longer industrial action lasts, the greater the potential for positions to harden, waits for patients to grow, and risks of harm to accumulate.

"We also want a resolution because we see the direct impact on the nurses we work with today, and those who we are developing for the future. While nursing remains a fulfilling profession, we hear from our nurses that many find their working conditions unsustainable. While recruitment numbers – particularly from international sources – have increased following the pandemic, nursing vacancies are close to 47,000 in England. Nearly 35,000 nurses left active service last year, a record number.

"Our view is that resolving industrial action is an essential first step to improving retention, which is in turn vital both for the delivery of care and for the financial sustainability of the health and care system. Pay and reward is central to the dispute, and we recognise is a matter for negotiation between government and unions.

"As leaders of the nursing profession on the ground, we know that sufficient staffing levels to service increasing demand and complexity, well-structured and funded professional development opportunities, and affordable pathways through both undergraduate and postgraduate qualifications to registration will also be critical if nurses are to feel valued and supported".

That is proper stuff. It'll be interesting to see whether this gains traction.

Primary colours

The BMA GP leadership this week rejected what they term to be an "unsafe and insulting: contract offer for England. This comes as the latest data from NHS Dighital suggests that the number of permanent GPs in England dropped (when compared with the year before) for the seventh month in a row.

There were 26,706 permanent qualified GPs working in England in December 2022 (down from 27,064 in December 2021).

The proportion of GPs in England working full-time remains at the lowest level since current records began nearly seven years ago. 23 per cent of qualified permanent GPs worked at least 37.5 hours a week in December 2022:e 69 per cent worked between 15 and 37.5 hours.

NHS performance remains appalling

The latest ONS publication on the impact of winter pressures is a predictably ugly read, as is the Winter SitRep data.

The Winter SitRep data is truly awful, as Stuart Hoddinott of the IfG notes.

Royal College of Emergency Medicine analysis shared with The Guardian found that the amount of time people over 80 spend in A&E in England almost doubled in the past year.

The RCEM's data analysis found that people over 80 are spending 16 hours in A&E waiting for care or a bed: the equivalent figure for 2021 being (an already-bad and dangerous) nine hours.

If you were setting Rishi Sunak some lines as punishment (clearly, Michael Gove would regard them as a reward), you might suggest the following:

"Optimism is not a plan.

"Optimism is not a plan.

"Optimism is not a plan."

Oh, and there's the small matter of the money

It's been bubbling under for a long time, but the fiction about NHS finances being on track(ish) has been officially busted. Taking a break from shouting pointlessly at ICSs/ICBs, NHS England's finance function has, as HSJ's smart Henry Andrerson noted, admitted that the system will end this financial year overspent by half a billion pounds.

And in reality, this will probably turn out to be quite a bit more.

Urgent and Emergency Care Plan launch

The Financial Times's Sarah Neville reported that Bonsai PM Rishi 'The Brand' Sunak promised that the new Urgent and Emergency Care Plan would deliver “the largest and fastest-ever improvement in emergency waiting times in the NHS’s history”, launching it on Teeside on Monday.

This plan includes the promise of 800 more ambulances and 5,000 hospital beds, and is supported by reallocating £1 billion in funding from the Autumn Statement's announcements of increased funding.

Our small-but-perfectly-formed PM responded to criticisms that the plan aims only to reduce ambulance response times to 30 minutes for category two call-outs (including suspected heart attacks and strokes), despite the official NHS target being 18 minutes.

The People's Rishi replied that the Government would work towards restoring response times to pre-pandemic levels “after next year”.

The BJF on the value of NHS management

It is never not funny to read the Boris Johnson Fanzine's desperate attempts to write anything pertinent about the NHS.

The BJF's ex-HSJ health journalist Laura Donnelly is again at the helm of this piece: the presentation of which absolutely ignores General Sir Gordon Messenger's insight about the importance of NHS management.

Messenger (rightly) says “I would argue that a really important component of that is a well-led, well-motivated, valued, resilient workforce, which comes from the culture, and the right attitude to leadership.

“I found an inadequate focus on that… and I would argue that unless you get the right culture, which means better leadership, it’s almost like painting the bedrooms without fixing the roof, in terms of throwing money at A&E waiting times.”

And what is the BJF's headline? 'Throwing Money At The NHS Won’t Solve Its Problems, Says Army General Turned Troubleshooter'

This editorial framing, and the associated commentary that runs around the article (as is always the case with the BJF), make this a particularly ostentatious bad piece, even in a media landscape that presents an awful lot of ostentatiously bad pieces about the NHS.

Cancelling consultancy

The Financial Times spotted that 'Crown Consultancy' has been quietly closed down, as the decision-makers in Government departments clearly prefer the revolving door to the Big Four.

The FT don't quite phrase it that baldly, but we all know the upshot.

The Alan comeback

Look, this hurts me as much as it hurts you.

Everybody's favourite Dunning-Kruger-meets-The-Peter-Principle-on-Mid-Morning-Matters ex-Health Secretary popped back up like an unflushable turd this week, on Good Morning Britain.

Among Alan’s many problems is that he has manifestly thought for many years that he is, indeed, a celebrity.

And now people are treating him like one.

But it's all fine because The People's Partridge is "only human" and - mmmmmmmmmmmmm - he "fell in love".

With himself, obvs.

EveryGrifter: here comes the book!

You've got to love EveryGrifter - or at the very least, have a certain admiration for their barefaced merch-vending grift under the pretext of 'championing the NHS'.

Yes, the very same NHS in which their non-GMC-licensed maker of fake threats of legal action leader Dr Julia Grace Patterson does not train/work, as of these past 13 years.

I am delighted to bring my Cut-reading fellow EG fans some wonderful news: this summer, we are going to be treated to 'EveryGrifter: The Book'! And so soon after we were treated to Alan's magnificent octopus: surely we must all have been very good indeed in our past lives.

Our heroine threatens us thus: "if we want the NHS to survive, the fight starts now, and we have no time to lose. I have written a book explaining what politicians are doing to the NHS and why they’re getting away with it. The book contains my behind-the-scenes untold account …"

It's wonderful, no? I'm sure there's a market for it: many people enjoy reading some fiction on their summer holidays.

Recommended and required reading

GSK boss Dame Emma Walmsley warned that the current dispute over drug prices in the UK is jeopardising the country's life sciences sector.

More in the FT on big pharma companies' discomfort with the NHS pricing mechanisms. Almost like an orchestrated campaign?

A watch, rather than a read: Tortoise's 'Suicide In Healthcare: How Do We Protect NHS Workers?'

The Department For Health But Social Care has only abolished three and amended two of the 137 retained EU laws post-Brexit (six are left unchanged). That leaves DHBSC with quite some work to do by year-end ...

Good piece on when and why not to collaborate, by Richard Taunt of Kaleidescope

The latest Institute For Government Whitehall Monitor report has concerning data about how civil servants morale and ambitions are playing out across the board.

The Department For Health But Social Care launched its 'new strategy to boost access to medical technology'.

The Financial Times has started celebrating the NHS's 75's 'birthday' early with this piece. (Can we please cut the anthropomorphic bullshit? Health systems are neither human nor sentient, and therefore do not have fucking birthdays.)

Curiously, I made it into US wealth bible Forbes. No, me neither.

The 'Review of the impartiality of BBC coverage of taxation, public spending, government borrowing and debt', by 'More Or Less' creators Michael Blastland and Andrew Dilnot, is thoroughly worth your time, especially given where this week's column started about UK politics: "we think too many journalists lack understanding of basic economics or lack confidence reporting it. This brings a high risk to impartiality. In the period of this review, it particularly affected debt.

"Some journalists seem to feel instinctively that debt is simply bad, full stop, and don’t appear to realise this can be contested and contestable ...

"Close attention to politics feels as though it ought to nurture impartiality. We find that without similarly close attention to the economics, it can be a threat to impartiality.

"Politically-led news is vulnerable to groupthink, just as politics itself can become a bandwagon, while other perspectives, perhaps from other specialists, speaking to the interests of other groups, are overlooked or crowded out".