Jun 18, 2023 13 min read

Cowper's Cut 275: The war for Streeting’s ear

This December 2020 Tory Party party video obtained by the Mirror is likely to help get Labour well over the line into Government in 2024.

Tactical voting evidence from the local elections already strongly suggested that The Conservative And Unionist Party was set to get smashed at the General Election, but this video is powerful. Moving pictures always are potent, even with PartiesGate being longstanding and very public knowledge.

It's also likely to massively inflame the Government's already-afire industrial dispute with the medical professions, many of whom put their lives at risk through the pandemic. Nobody should underestimate the extra motivation that this will give the BMA and RCN.

Health But Social Care Secretary Steve 'The Banker' Barclay is backed even further into a corner. It couldn't happen to a slightly duller man.

The war for Streeting's ear

As the dropping of the political penny starts to resonate more widely, the cumulative effect of this is that the war for shadow health secretary Wes Streeting's ear is going to become much higher-stakes. It has the potential to make The War Of Jennifer's Ear look like a playground scrap over the last tuck-shop gobstopper.

A weekend Guardian interview to promote his memoir saw Labour moderniser and shadow health secretary Wes Streeting admit that he'd like to be Prime Minister. He was also asked about health policy, and specifically about Kaleidescoper Richard Taunt's fine recent commentary piece suggesting that the NHS may not make it to 100.

Streeting's answer is "I do believe it is salvageable. It requires three big shifts: from an excessive focus on hospital care to more focus on neighbourhood and community services; from an analogue service to one that embraces the technological revolution; and from sickness to prevention. If it does all three things, it will be an NHS fit for the 21st century”.

That sounds lovely, albeit a bit 'it's nice to be nice': Mr Streeting will have to start to know how those three rather large aims will be accomplished. A new government, shorn of ministerial experience and far from cash-rich, will have no room to make mistakes, nor to waste time on finding and sticking to the right approach to fixing the NHS and the care system.

It is going to matter enormously who wins the war for Streeting's ear.

ConfedExpo

ConfedExpo - the co-production of the NHS Confederation and NHS England in which the latter seem curiously intent on denying any role - happened this week.

Confed chair Lord Adebowale and NHS England chair Richard Meeddings gave a pair of strong opening speeches.

NHSE director of *ahem* strategy Chris Hopson told delegates that the long-awaited workforce strategy was "a really good and impressive piece of work".

Mmmmmmmmm. Right. So when is it being published, Chris?

"Soon". Ah. That best of all deadlines.

Fire with Amanda Pritchard

NHSE chief executive Amanda Pritchard's speech also mentioned the workforce plan, of which she said "its (sic) first, medium and last in our priorities (what?) ... I’m hopeful that the Long Term Workforce Plan will be published very soon".

That is NHS England's workforce plan, Amanda: the organisation of which you are (pro tem) the actual chief executive.

Her assertions ranged from the absurd

"locally, ICSs are not just words in a statute book, they have become a way of working" (while NHSE cut their management budgets by 30%; force them to lie about hitting financial balance; and put them into special measures if they don't lie about finances)

to the fictional

"We’re only a year into ICSs, but we are a year in (again, what?) ... we have co-created our new Operating Framework, bringing shared understanding to how we all work together"

and on to the farcical

"the NHS in England living within its means, despite the real pressure on budgets caused by inflation, and in doing so delivering more than five billion pounds of efficiencies" (HSJ revealed billions of unspent Covid19-era cash was used to balance the books last financial year; nobody in their right mind believes this year's financial plans; and the £10 billion estates backlog (mostly urgent) could use some of that fictional £5 billion in efficiency gains).

Ms Pritchard also said, "the NHS is facing challenges. They are different challenges, but they are just challenges". It is among the worst lines you could write, let alone say. Her aim was, she told delegates “to fire you up”: ironic when so much of the system is on fire.

After her speech, at the start of the Q&A, Pritchard said that she was "slightly discombobulated by the number of people now leaving”: an auto-nationalisation of a public self-own, as well as working perfectly on multiple levels.

This was a truly dire speech, devoid of internal logic. I cringed so hard, I think I might have broken something.

It was aimed at an audience of one: Health But Social Care Secretary Steve 'The Banker' Barclay. Its whole subtext was 'please don't sack me', with a side order of 'the NHS is good, people like it'.

Her personal workforce plan/plea seems unlikely to, erm, work. Mr Barclay clearly doesn't rate her; nor does the Sunak 10 Downing Street operation: they openly discuss this, and say how much they'd prefer Sir Jim Mackey.

So, expect briefings against Ms Pritchard to start over the late summer, and to rise in frequency and venom through the autumn. She'll probably be left in place to carry the can for what seems set to be another appalling winter; and set free in the spring due to winter and backlog issues.

Prevention, AI and car park payment terminals with The Banker (oh, and trusting ICSs)

The Banker's ConfedExpo speech? Basically a long list of what the Government is spending money on, shorn of any unifying theme. Our Steve was exercised variously about the internet of things, the AI, the cloud, and car park payment terminals. It really was that coherent.

"The NHS has changed massively over the last 75 years". Riiiiiiight. (Has Wes Streeting got a mole in deep cover, writing Barclay's speeches?)

Oh and prevention is "really exciting", but not "stale conversations about what things to ban". It's all about "empowering people to make the right choices". Just like with car seatbelts, or smoking in pubs.

But The Banker's finest moment was lecturing delegates on "the importance of trusting ICSs".

Ahem.

Ahem-ahem.

Ahem-ahem-ahem: as HSJ editor Alastair McLellan noted, the Government response to the Hewitt Review recommendations is to stonewall or reject most of them. Way to trust, Steve: 10/10, no notes.

In the Q&A, The Banker said that he thinks it's an "8 or 9 out of 10 likely" that the workforce plan will be out by the 75th NHS anniversary.

You couldn't even cringe at this, it was so dire: it was just a question of sitting tight and waiting for it to stop.

The DHBSC's beige era

The Department For Health But Social Care issued its promised response to the Select Committee ICSs report and The Hewitt Review.

It's genuinely impressive. It says nothing of any value whatsoever, at huge length. The section on finances and funding is remarkable.

On reviewing the NHS capital regime, it grandly announces "we will set out next steps in due course". (Steve Black's latest HSJ column is a decent overview on the currently chaotic nature of this.)

The DHBSC must be congratulated: they have turned the concept of beigeness into a document.

They repeated this trick with the Mandate. That is, at least, shorter. Speaking at ConfedExpo, The Banker said of the new Mandate "what we’ve done this year is make it short and clear, setting out our priorities: cutting waiting lists; the 3 recovery plans; tech and workforce.

"It gives a clear direction and backs it up with the freedom and flexibility to deliver it. We know that change happens when people are trusted, have a common purpose and are free to innovate."

I mean, maybe. We'll see.

The Inquiry opens

The UK Covid19 inquiry opened this week: its hearings are livestreamed. There is a high probability that staff who worked at the front line during the pandemic will find the inquiry's evidence re-traumatising.

It was interesting to see this Friday that the DHBSC lost its long FOI battle with The Times' George Greenwald to keep secret its internal September 2020 'lessons learned' report. It was not surprising: the report details how DHBSC officials "failed to release emergency-trained staff from day-to-day roles at the start of the pandemic to help manage the crisis".

It also outlined "key shortcomings in how the NHS co-ordinated with the elderly care sector".

Politico reports that Shadow Social Care Minister Liz Kendall said she is “open to discussion” with other parties about long-term reform of the social care system. Speaking to the Power Test podcast, Kendall said she wanted to see social care put on “an equal footing with the NHS,” but disagreed with the central idea of a Fabian’s Society report proposing a National Care Service.

(Wes Streeting wrote a Fabian Society pamphlet in 2019 supporting the Jeremy Corbyn policy that capital gains tax should be equalised up to the level of income tax: it is mentioned in his Guardian interview.)

Breaching Alan's Protective Ring

I really had hoped only to have to write about The People's Partridge in passing. But alas, Alan's alarming antics returned to the news agenda this week.

I'm grateful to palliative care doctor and bestselling author Rachel Clarke for spotting Alan's appearance on TikTok (the MySpace for Gen Z), furthering his 'celebrity' career by talking about his favourite drinks.

@matthancock
Ranking 5 drinks without knowing what comes next... I can't stand #WKD 🤮🤣
♬ Sunshine - WIRA

Alan's former colleague Helen Whateley, asked by The Guardian if she agreed with the assertion made by The People's Partridge that "we absolutely did throw a protective ring around care homes", parried with the line that she wants to “use my own words which is that I look back on doing everything I felt that we could to help care homes and social care more broadly at an incredibly difficult time”.

I love the smell of scapegoating in the morning. Let’s hope the Inquiry findings don’t threaten Alan's celebrity career opportunities.

On the topic of Alan's Protective Ring, I did a little 'Cowper's Cut' archive dip, and found that this May 2020 piece holds up OK: "it is not edifying watching and reflecting on the human embodiment of the Dunning-Kruger effect going about … whatever it is. Alas, Mr H*nc*ck’s performance at the Friday briefing was sufficiently shoddy as to be worthy of comment.

Mr H*nc*ck’s assertion that “right from the start, we’ve tried to throw a protective ring around our care homes … we’ve made sure that care homes have the resources they need to slow the spread of infections” is striking, as is his re-emphasis later that “we’ve worked incredibly hard to throw that protective ring around our care homes”.

"Tried. Worked incredibly hard. The government’s Colt Seevers figure (“The Fall Guy”) is casting around for a “school report for the dim child” defence.

"It is not easy to swallow. Look at the latest ONS data on deaths in care homes.

"Look at the justifiably outraged response of Martin Green of Care England speaking to the Financial Times, asking to “see the evidence of what exactly the protective ring consists. Ask [Mr Hancock’s] office when exactly they instituted this protective ring."

That column concluded, "we have a Government that is proving itself to be impressively inadequate. As I have previously written, nothing reveals a leader’s character more than being found out, and the current leadership is being found out a very long way indeed.

"Prime Minister Boris Johnson clearly has a bit of a thing for the UK’s great 20^th century wartime leader Winston Churchill, and would like to remind us of him; but is in practice reminding us rather more of Churchill the insurance advertising dog (albeit a slightly less animated and useful version).

"It’s the political equivalent of finding out that you’ve got a good-time girl when you need a warrior queen. And even Mr Johnson’s admirers within his party are starting to notice. The public will notice, too, that Mr Johnson’s Churchill fantasy (Winston edition) is as distant as ever. The PM seems to think he’s Prince Hal, when in reality, he’s Falstaff: this confusion is not likely to end well for him."

Funny old world.

Of determinants and determination

In their new piece on the public health grant, the Health Foundation point out that "the public health grant has been cut by 26% on a real-terms per person basis since 2015/16. Even taking into account additional but time-limited funding for drug and alcohol treatment, real-terms funding is 21% lower".

Productivity, or what you will: where did all the extra staff go?

The Institute For Government (funded by the Health Foundation) and Public First published a fine piece of analysis from Sam Freedman and Rachael Woolf. 'The NHS productivity puzzle: Why has hospital activity not increased in line with funding and staffing?' is a thorough and thoughtful analysis and commentary on probably the key topic for the rest of this financial year.

The report's authors "identified three main areas that are contributing to the current situation: the lack of capital investment, which has made it harder to treat patients and caused inefficiencies; high staff churn, more inexperienced staff and low staff morale; and problems with hospital management and incentives from the centre.

"All of these problems were present before Covid, but the extra strain on the system has created a perfect storm." Quite.

LASt chance for GP access?

London Ambulance Service are behind this rather curious pilot proposal written up in The Times, which plans to divert patient phone calls to GP surgeries to NHS111, where spare paramedics will be redeployed to triage or resolve their needs and wants.

This is interesting timing, in the same week when BBC London News reports that LAS virtually fell over due to heatwave/pollenwave demand.

There is also the really rather curious underlying strategy of suggesting that NHS111 is the answer, other than to the question 'what's the best way to get told to go and see your GP/walk-in centre/A&E?'.

There is also the fact that LAS's staff retention patterns don't necessarily suggest that they are an organisation who should be used as models.

Strikes

As the three-day juinior doctors strike began, Health But Social Care Secretary Steve 'The Banker' Barclay tweeted "at recent meetings with BMA Junior Doctors, we made a fair & reasonable opening offer & were discussing both pay & non-pay issues until they chose to end the talks".

"Opening offer" is new language from The Banker: could the penny belatedly be dropping that he's not in a strong position here?

The BMA Junior Doctors Committee leadership wrote to PM Rishi 'The Brand' Sunak, urging him to get involved in negotiations. Doing that day's media round, Wes Streeting made the same point, telling BBC R4 Today "I think the reason junior doctors are out on strike is because they don’t have someone to negotiate with. I think the question at this stage, having failed to get to a negotiated settlement is, 'where’s the Prime Minister?'

"If he’s got an hour of his time to sit with Boris Johnson negotiating gongs for cronies and peerages in the House of Lords, he should have an hour at least to negotiate an end to these terrible strikes which are causing misery for the doctors involved - and even more importantly misery for patients who are seeing their operations delayed and cancelled".

This line got a round of applause when re-used in Streeting's well-received speech at NHS ConfedExpo. Outside the venue, JDC co-lead Rob Laurenson told demonstrating doctors that "the strikes will go on until we win". The BMA plans to re-ballot junior doctors, with a view to renewing a mandate for industrial action running up to March 2024.

Cronyvirus and coronamillions update

Still very quiet on Tory peer The Noble Baroness Mone, and whether she believes everything she thinks. But this stonking story in the Mail keeps things warm, with the revelation of the fly-tipping of a vast amount of PPE in the New Forest.

It will, of course, be traceable. After all, the Government has the receipts.

Happy Birthday to 'Cowper's Cut'

I am among those who think that, being as it is a health system, the NHS may perhaps be said to have anniversaries, but unquestionably does not have birthdays (such as its ubiquiotous upcoming 75th 'birthday').

Sigh.

However, a recent archive dipping expedition brought it to my attention that this Monday sees the sixth 'birthday' of Cowper's Cut. The first column was published in Health Service Journal on 19 June 2017.

God, I'm old. Anyway. Some thank-yous are in order.

The first is to HSJ editor Alastair McLellan, who gave me the opportunity and challenge of writing a weekly column.

The second is to the colleagues and friends who have helped me with guidance, leaks, carrots, tips, corrections and clarifications. It's appreciated.

And the third is to you, the subscribers. Writing this is quite labour-intensive, and couldn't happen if you were not willing to pay. You have been. Thank you for that.

I'll keep doing my best to make sure it's not shit.