Cowper’s Cut 269: Through the looking glass

We began this week with the Government's attempt at euthanasia.

New plan to make it easier for patients to see their GP

Action to make it easier for patients to contact their GP and end the 8am rush, with £240m given to practices across England to embrace latest technology.

GOV.UKDepartment of Health and Social Care

Their aim must be to make members of the Reality-Based Community die of laughter, given their suggestion that a £240 million bung to primary care would fix the 8 am daily scrum for GP appointments.

The concept that GP phone systems are significantly responsible for the problems with primary care access is damagingly laughable, when you look at the number of GPs leaving the profession. The Institute For Government's latest Performance Tracker has the data.

If new phone systems were the key to resolving the problems with GP access, then GPs would have invested in them years ago. As they did with IT systems.

Pharmacy to the (closed shop) rescue!

But of course 'pharmacy can pick up the strain we've seen in primary care'.

Or perhaps could, if it wasn't seeing closures on a really significant scale, as this BBC News analysis of NHS Business Services Authority data shows. 160 community pharmacies in England have closed over the last two years, leaving 11,026 - the lowest number since 2015.

Primary care recovery plan

These were parts of the primary care recovery plan, which appeared this week, and probably wishes that it hadn't. Like the Hewitt Review, it evidently means well; but is unequal to the actual task of expanding the workforce in the short term, which is the only way to make a pertinent difference.

(We know how that is done, as I've pointed out: it's immigration of qualified GPs from other countries (many of whom can't afford to lose them); and it's bribing the recently retired appropriately vast sums to come back.)

The Commons debate was mostly poor, but Wes Streeting scored bonus points for the Alan Partridge reference in his response. I wonder which former Health Secretary might have triggered this?

The Institute For Government's Stuart Hoddinott offers this polite but pointed takedown of the proposals.

Through the looking glass into fictional health policyland

We are a long way through the looking glass, and deep into the realm of fictional policy solutions.

But why would that be a surprise? After all, we have the Conservative And Unionist Party's manifesto commitment to delivering 40 New (If Fictional) Hospitals to which we can look forward. (Or is it 48 this week?)

The Forty New (If Fictional) Hospitals Programme got a timely burst of publicity, with Dr Ruth Charlton, the chief medical officer of Epsom and St Helier University Hospitals NHS Trust writing for The Observer that "right now, we are delivering safe care – but it’s not easy in such a dilapidated and unpleasant environment, and I fear we won’t be able to provide the level of care we’d like to – or should be – for much longer.

"Our patients and our staff deserve so much better than this current state – where wards are being shut down because the foundations are sinking, and floods and leaks are a certainty every winter. Every day we wait costs money, and each year we have to spend more and more on updating our old, rundown buildings, diverting scarce resources from the front line."

The pending National Audit Office report into the Fictional Forty will no doubt pick up on the general sense of disbelief in the service that the Fictional Forty are actually going to materialise in the real world, ever. This vibe (quite familiar to 'Cut' readers) was put on steroids by the revelation by Health Service Journal's Zoe Tidman and Nick Carding of New (If Fictional) Hospitals Programme data that the total cost of building these manifesto-promised-but-fictional forty new hospitals by 2030 will be £35 billion.

Dr Charlton reveals that "this month my tenure as chief medical officer at the trust comes to an end", which partly explains this atypical outspokenness. But something else is happening here: it's not just demob-happiness by one CMO.

There is an active sense of a dying Government.

Whether it is the Home Office using Statutory Instruments to force rejected clauses of legislation,

or Kemi Badenoch's blatant contempt of Parliament and the Speaker, the signs of a Government that is starting to die of arrogance are multiplying.

Blatant politicisation has arrived with a bang, with Health But Social Care Secretary Steve 'The Banker' Barclay's decision to refuse to approve about 30 proposed community diagnostic centres (designed to speed up cancer treatment) unless they can be delivered in 2023, as Health Service Journal has been told.

This is ugly stuff, if unsurprising.

Even a chief medical officer who's leaving doesn't want to jeopardise the prospect of any future capital investment by speaking out in the national media. What looks to be happening here is that people no longer believe that these decisions will be made in the rest of the Government's tenure.

And given The Banker's deserved reputation for vacillation, we can quite see why.

If this impulse to outspokenness spreads, things will get leakier and livelier.

Indeed, The Banker looks set to achieve plenty more of this kind of response.

The Respect-Off continues

The appropriately-named (well, historically) Royal College of Nursing Congress is now under way, and general secretary Pat Cullen has drawn headlines for her demand in this Sunday Times interview of new negotiations starting with a double-figures pay increase for nurses.

Cullen added heaps of job-protecting praise for RCN members: “my message to them is just how proud I am of them and of their courage. They are the most courageous people . . . Looking back on this pay offer, I may personally have underestimated the members and their sheer determination. And I think what I would be saying to the prime minister, Rishi Sunak, is, ‘Don’t — don’t make that same mistake, don’t underestimate them’.”

Her warning about next steps if negotiations don't resume was unambiguous: “they [ministers] owe that to nursing staff not to push them to have to do another six months of industrial action right up to Christmas”.

Following last week's Respect-Off, we can be quietly confident that Team Barclay will respond in briefed kind.

Missed targets

The mid-week data dump made two probable things into certainties: that the 18-month target had been missed, and the RTT backlog had grown to 7.3 million. Prime Minister Rishi Sunak said, “I promised I would cut NHS waiting lists and we are delivering". Ahem.

James Illman's analysis for HSJ is worth reading, as of course is Rob Findlay's: his tagline that "achieving the next targets will need a more sophisticated approach than targeting cohorts of long waiters" won't become an operational mantra within DHBSC's wholly-owned subsidiary NHS Engroovement any time soon, but should.

It's funny what pointless and avoidable industrial action can do to make a dreadful situation that good bit more dreadful. Still, at least the Government's looked tough with its Thatcher cosplay, because the healthcare workforce is exactly like the National Union of Mineworkers in the 1980s. The Enemy Within, innit.

Positively, there were improvements on the 62-day cancer target.

"I'm afraid there is no money"

Nuffield Trust data diva Sally Gainsbury was once again being unhelpfully reality-based this week, pointing out that the staff pay award is indeed not fully funded by the Department For Health But Social Care.

NHS pay settlement: ministerial direction request

Letters between the Permanent Secretary and the Secretary of State for Health and Social Care regarding a ministerial direction for the NHS pay settlement.

GOV.UKDepartment of Health and Social Care

This process involved DHBSC permanent secretary Chris Wormald asking The Banker for a written ministerial direction to conduct this transaction. (This harks back to NHS Engroovement CE Amanda Pritchard asking Blockbuster SOS The Saj for a similar thing on using independent sector contracts in January 2022. BlockSaj said 'yes'.)

Sally concludes that "NHS organisations have been given the dosh (by DHBSC) to cover the bonus pay (well, a reasonable estimate of it). But the DHBSC have essentially funded that out of an unarranged overdraft."

Funded out of an unarranged overdraft. Mmmmm.

What could conceivably go wrong?

Sorry: wrong number

NHS Engroovement's revealed preference to be lied to by ICSs about the financial forecast for 2023-24 was foregrounded by South Yorkshire ICS's board being unusually frank about gaming the system, as HSJ's Henry Anderson spotted.

Just as the St Helier CMO's comments about the Fictional Forty shine light on attitudes to The Banker, so does this show the widespread respect in which NHS Engroovement's policy of promoting fiscal mendacity is held by the service.

This is unprecedented. The Chartered Institute of Public Finance Accountants' policies on financial reporting emphasise the need both "to hold those charged with governance of the authority to account for the performance of the authority" and "to provide sufficient comfort to regulators that authorities are acting within their boundaries".

It is unclear how suborning blatant lying about financial plans, as NHS Engroovement flagrantly does here, meets these tests. NHS Engroovement is the governance, and it is the regulator. This is going to come back to bite.

(Note for NHS Engroovement: "the principles apply equally to internal reporting". I'd get much better legal advice, if I were you.)

Staff burnout - Long Covid Mark Two

I mentioned post-pandemic staff burnout in last week's column as a Very Much Not Gone Away issue: this striking piece by Matthew Swindells and Dr Sarah McNeilly in Health Service Journal and this in the Financial Times both rather reinforce the point.

Steve Brine assaulted by Commons standards commissioner

Health Select Committee chair and ex-health minister Steve Brine was found guilty of failure to declare a financial interest in Remedium Partners healthcare workforce agency when he approached two colleagues in Government to promote their availability.

The standards commissioner concluded that "neither approach contained an adequate declaration of Mr Brine's outside  interest. This is because neither approach clearly detailed that he was in paid employment with Remedium.

"I decided that these failures to properly declare both amounted to a breach of paragraph 14 of the 2019 edition of the Code."

Aloytius Parsadoust wipes out original shareholders (again)

You can't keep a good man down - and you can't keep Aloytius Parsadoust down either. Those with either shareholdings or schadenfreude in Babylon will have been struck by this week's investors' announcement that funding had been raised on payday-loan-type interest rates to take Babylon private again.

Yes, it would be a shame if The People's Partridge had sunk his I'm A Celebrity fee into Babylon shares, wouldn't it?

Laughably bad coverage in the Sunday Times managed to somehow link Babylon's financial incontinence, AI hype-nonsense, dodgy symptom-checker algorithms and wild overvaluation with its NHS contracts.

No: me neither.

This dismal piece also managed not to point out that this was Aloytius' second turn at the 'destroying healthcare shareholder value' rodeo: the original shareholders of (ahem) 'workers' co-operative' Circle were similarly wiped out in 2013 by the legacy of Aloytius' economic mismanagement there.

First Circle, then Babylon: next 'A-ha! Healthcare'? With Aloytious as chief executive, and Alan as chair? The dream team incarnate: there's got to be a sitcom in it. 'When Alan Met Ali'?

Recommended and required reading

Piece in the New Statesman on why training more doctors alone is not enough.

The New York Times should win every major award going for gullibility for publishing this grotesquely gushing profile of convicted Theranos fraudster Elizabeth Holmes.

Former Countess of Chester Hospital FT chief executive Susan Gilby is suing the trust on the grounds of bullying by chair Ian Haythornthwaite, HSJ revealed.

BBC News reports a delay to the closure of the Tavistock and Portman GIDS.