Cowper's Cut 270: Labour's 'Leopard' health policy? That's novel ...

The week began with the less-than-astonishing announcement that the Government's talks with the BMA Consultants Committee leadership about pay had been unsuccessful.

The consultants' ballot for industrial action by consultants has opened, and will close on 27 June, with the leadership recommending that members vote for industrial action.

So what's happening with the Royal College of Nursing vote on extending their industrial action in  the wake of the NHS Staff Council voting to accept the Government's pay deal?

Certainly, those briefing the i newspaper are expressing low levels of confidence in another vote for further action, in the vote that opens on Tuesday.

Cullen did receive a standing ovation at the RCN Congress, though - and was boosted by being able to report to her members that Secretary Of State For Health But Social Care Steve 'The Banker' Barclay had just emailed her to request a meeting - but, obviously, not one at which they were to re-open negotiations about pay.

Capital

The issue of capital spending has been a theme running through the ongoing mythical saga of the Forty New (If Fictional) Hospitals. Health Service Journal's Zoe Tidman analysed data and revealed that over half of £2.7 billion awarded to NHS organisations for capital projects in 2017 and 2018 remains un-delivered.

The article reports that "the 143 schemes, worth a total of £2.7 billion, known to have been included in the “sustainability and transformation partnership” capital funding programmes (STPs were the forerunners of integrated care systems).

"Only £1.2 billion has been given to the organisations involved, and over a fifth of live schemes – which range from emergency department upgrades to new primary care hubs – have not received any allocated funds to date."

In bathos-drenched coverage, BBC News journalists discovered that "building work is yet to start for 33 of the government's 40 promised new hospitals in England". No! Really?

One must have a heart of stone not to laugh at this curiosity-free, proper-research-light pap. These journalists' notion of the vast bulk of the Forty New (If Fictional) Hospitals Programme as being 'pending', as opposed to 'never going to happen in the real world', is an impressive marker of the extent to which the BBC (which was once the nation's independent and trusted broadcaster) has become a cowed, fearful and inept stenographer for the current Government.

Financial mendacity, as commissioned by the NHS Commissioning Board

I wrote in last week's column about NHS Engroovement's suborning of ICSs to produce dishonest financial statements.

This trend is obviously ongoing: Health Service Journal's Henry Anderson highlighted the Greater Manchester Integrated Care Board reporting that they forecast over £100 million in deficits across their NHS providers.

Happily, the ICB have decided that this can be balanced out by £115 million in as yet "unidentified system savings", and so has now submitted a breakeven plan. What a relief!

There are no possible negative consequences to The Artist Formerly Known As The NHS Commissioning Board commissioning ICSs to lie about their financial plans.

None whatsoever. There is no precedent in the NHS's past of this leading to problems of any kind.

Nothing could conceivably go wrong.

ICSs definitely couldn't be the centre of problems, as HSJ observed, reporting NHS Engroovement finance director Julian Kelly's remarks at last week's board meeting that one-third of ICSs submitted deficit budgets for 2023-24 despite the Commissioning Board's high-profile blandishments to lie covered in recent times.

14 of the 48 integrated care systems in England have forecast a combined deficit of £650 million (an evidently fictionally-low number) in 2023-24: last year, just five had the nerve to do so.

As I say, there is no way this could lead to any unfortunate of unforeseen consequences. It will all clearly be absolutely fine.

What a relief!

Workforce

The Banker's Twitter account was puffing out the latest data about the DHBSC's attempts to recruit its way out of a staff retention crisis.

Alas, The Times' Kat Lay had information from the Nuffield Trust about the unsustainable nature of the current use of international workforce imports to help the NHS appear to hit its targets. The piece reports that "in the year to September 2022, 50 per cent of joiners to the UK nursing and midwifery register trained overseas. This was up from only 19 per cent four years earlier".

In 2021-22, India, the Philippines and Nigeria were the three biggest providers of overseas registrants (internationally-trained new joiners) onto the Nursing and Midwifery Council database.

Also in The Times, the Government's U-turn on banning 'off-framework' recruitment of locum and agency staff was highlighted. Care minister Helen Whately's letter to agencies in December 2020 described eliminating off-framework spending as “one of our priorities in the NHS ... off-framework spend is not sustainable, not a cost-effective use of taxpayers’ money and does not create safe care for our patients.

"If you are committed to the same objectives and want to be part of our supplier community for the future, we look forward to working with you to eliminate off-framework spend by 2022”.

Ahem. The Times story notes that in a recent written answer to a Parliamentary question from Labour's health lead Wes Streeting, health minister Will Quince wrote, “while we have not set a target date for stopping NHS spending on off-framework agencies, we continue to bear down on their use".

Yes, I'm relieved too.

Drug trials and tribulations

Shadow health secretary Wes Streeting gave this interview to the Financial Times promising that if elected, Labour will re-emphasise clinical trials and simplify their roll-out across the NHS.

Streeting told the FT, "it’s no bad thing that people coming up with new ideas, new inventions, new treatments, are in the private sector. I think we’ve got to get over some cultural sniffiness there ... the NHS can’t lose hundreds of millions of pounds of commercial trial income almost accidentally and not be bothered about it”.

Labouring or Leoparding towards an Opposition health policy?

Judging from his dramatically-insubstantial NHS policy comment piece at the weekend (placed in the Boris Johnson Fanzine by the Department For Putting Tanks On Lawns), Labour leader Sir Keir Starmer's clearly been on the Lampedusa in a big way.

Giuseppe Di Lampedusa's masterpiece 'The Leopard', a novel about the huge changes in Sicilian society during the risorgimento, contains the genius line "if we want everything to stay as it is, everything has to change".

This appears to be Sir Keir's health policy driver.

He writes, "faith in the promise of the NHS – the model of a universal, free at the point of use system – remains absolute. For 75 years, it’s been part of our national story; a source of comfort, security and health for millions. This is what we must preserve.

"But on the other hand, public satisfaction with the NHS has never been lower. More than 7 million people languish on waiting lists. Ambulances come too late. In some parts of the country, getting a GP appointment feels almost impossible.

"This must change. My response is to throw everything at reform". Which would be nice, if Sir Keir could tell us at what reform he plans to throw everything.

But Sir Keir does not. Instead, we get mumbling about "care ... closer to home. Where patients have more control. And where we put prevention first, right across society. We’ll be optimistic, too".

That might all be jolly nice, but it is unquestionably not a plan (He did mention the Streeting FT interview clinical trials stuff.)

The content of this piece is insubstantial to a probably predictable degree, but there is a live question as to whether Labour know what 'the change they want to see' in the NHS actually is.

Presently, it is far from clear that they do. On the BBC's Laura Kuenssberg Show, Labour health lead Wes Streeting hinted at increasing patient choice of providers with shorter waits within ICSs: this is, at least, an idea. How widely viable an idea it is, remains to be shown.

Streeting also touched on the importance of making the food and drink industries more accountable and responsible, which is a reality-based idea.

Perhaps Sir Keir's much-trailed NHS policy speech on Monday will make things clearer: it rather needs to.

The Alan comeuppance

Excellent: The People's Partridge and Isabel Oakeshott are reigniting their public row, and guess what? They can both lose, and they are!

This is to do with Alan trying to put the legal frighteners on venues for a live version of Oakeshott's 'The Lockdown WhatsApps', in which noted buffoon Lawrence Fox is involved. In perhaps the ne plus ultra of pots calling kettles black, Oakeshott writes about Matt Hancock's "brass neck".

Yep, let's draw a veil over that. Unlike Alan's WhatsApps, published this week by the Good Law Project, which don't greatly enhance his reputation.

Our Dear Leader and former Conservative And Unionist Party MP, who lost the whip for going on 'I'm A Celebrity' without permission, was on the scene again mid-week, telling a meeting of Tory thinktank Bright Blue that "we've got to embody the socially liberal, positive values that people under 50 overwhelmingly support. Because if we don't do that, then the Conservative Party will die".

Mmmmmmm.

Just a reminder: Alan did actually attend Cabinet for many years, and has frequently met both Suella Braverman and Kemi Badenoch in real life.

Alan also appeared on LBC's 'The News Agents' podcast this week, claiming that "I have put myself through an extraordinary amount of scrutiny over everything that's happened".

Mmmmmmmmmm.

Recommended and required reading

This BBC Panorama investigation found that private providers of ADHD diagnosis are a bit on the not-too-thorough side.

The Boris Johnson Fanzine reported that BUPA customers are having to endure lengthy waits on the phone to speak to staff. I can almost hear it now: "we are experiencing high levels of demand ... please stay on the line: your call is important to us".

"An important part of this should be new academy-style NHS trusts, where successful leadership teams share best practice with poorer performing areas." Why not call them Foundation Trusts? Yep, The Saj has another 'Blockbuster service in an age of Netflix'-type epiphany in this laughable Times op-ed piece.

Detailed FT piece on the current state of the Conservative And Unionist Party; David Gauke's take in the New Statesman is also a good analysis.

Tussell have released 'Healthcare Titans', their latest NHS suppliers Rich List.