Cowper’s Cut 297 BankerExit: Steve Barclay removed as the NHS goes on the Atkins diet

BankerExit

We’ve been de-Bankered. And so we say farewell to bafflement poster-boy Steve ‘The Banker’ Barclay, who this week was downgraded to Environment Secretary.

If you’re in doubt about that move being a downgrade in PM Rishi ‘The Brand’ Sunak’s eyes, The Banker has been swapped in to take over at DEFRA from Dr Tiz herself: Liz Truss’s spirit animal and Oxford comma fan Dr Therese Coffey.

Barclay thus joins Coffey, himself, Javid and Hancock on the lengthening list of former Tory Health Secretaries whose tenures left zero discernible positive achievements.

I wrote about the Barclay legacy for the BMJ.

Steve Barclay’s legacy as health secretary

We should feel equally sorry for the world of reality television and the Department for Environment, Food, and Rural Affairs (DEFRA). Clearly, that is where we throw our failed former health secretaries. Matt Hancock, previous health secretary, continues his Pyrrhic quest for national treasure stat…

The BMJCowper A.

Still, at least Steve Barclay really whipped the NHS into shape.

The NHS has warmed to Barclay, but his biggest test is to come

Matthew Taylor shares his insights on what the new reforms proposed by the Hewitt review will mean for the NHS and the population health outcomes

Health Service JournalMatthew Taylor

(Oh, and this will never not be funny.)

The Atkins diet

And so welcome, perhaps, to Victoria Atkins, who becomes the fifth Secretary Of State For Health But Social Care in the past two-and-a-half years.

OK: two of them were Steve Barclay, but it’s still a remarkable rate of churn.

Mrs Atkins is a more liberal Tory MP than most. She trained as a barrister specialising in fraud trials, which will prove handy as she approaches the legacy issues from the pandemic procurements - most notably Tory peer Baroness Michelle Mone’s involvement in PPE Medpro.

Those who have dealt with her report her to be intelligent, committed and a good listener: she was very well regarded for her work as victims minister.

Her voting record is here.

Mrs Atkins’ debut has been marked by the posting on Kiss (formerly known as Twitter) of the strangest PR clips.

In the first, she was broadcasting about listening, which is niche as can be.

‘Victoria Atkins: The Movie’

This second clip is even more bizarre. The vibe is ‘royal visit’: the applause from DHBSC staff (or are they SpAds?) is deeply strange, and slightly North Korean.

Then there is the slow-motion handshake at the beginning, to add dramatic tension. There’s bound to be a still frame in the next one, progressing to jump cuts and drone shots overhead as her PR team’s confidence and budget grow.

This is cult of personality stuff. It is politics as performance.

Worryingly, it’s very Alan.

Health and Social Care Secretary speech at NHS Providers

The Health and Social Care Secretary gave a speech at the NHS Providers conference on 15 November 2023.

GOV.UKDepartment of Health and Social Care

Mrs Atkins’ remotely-given debut speech at the NHS Providers conference is fairly full of untruths, which at this stage of her tenure in the job is entirely down to her DHBSC handlers.

They are, nonetheless, worth noting. The words put into her mouth assert that “we know winter will be challenging. But this year, we have all started to prepare earlier than ever before.”

This is untrue.

NHS England » Winter Plan – 2023/24

NHS EnglandNHS England

Read this NHSE Winter Plan: (OK, published in late July).

Now let’s look at the achievements of what it plans.

“All the interventions over winter should contribute towards the two key ambitions for UEC performance of:

•76% of patients being admitted, transferred, or discharged within four hours by March 2024, with further improvement in 2024/25.

•Ambulance response times for Category 2 incidents to 30 minutes on average over 2023/24.”

The NHS in England is nowhere near either, and I confidently predict will not be anywhere near by March 2024.

As the Association Of Ambulance Chief Executives’ recent report shows, “daily average volume of Category-2 incidents reached its highest since April 2022. Response times slowed for each Category: Mean Category-1 response reached eight-and-a-half minutes, and Category-2 over 37-minutues: both continue to exceed their respective national standards”.

Mrs Atkins’ DHBSC scribes also had her claim further things that are likewise demonstrably untrue: “we’ve got clear recovery plans in place. Financial certainty for the rest of the year. And the first-ever, fully funded, reform-focused, long-term workforce plan.”

Ahem.

Electives and capital to be cut after Treasury refuses £1bn strike cash plea

The NHS’s work to bring down the 7 million elective waiting list is being curtailed, after the Treasury refused to fund most of a £1bn NHS deficit driven by strikes.

Health Service JournalHenry Anderson

The recovery plans, which had very low credibility because there were no evident means of delivering key aspects of them such as hitting 130% of pre–Covid elective activity, have just been scaled back because of the funding shortfall due to strikes.

There is no financial certainty for the rest of the year: the latest NHSE finance board papers show how far the NHS is in deficit at the end of Q1 of this financial year: three-quareters of a billion pounds.

And The NHS Long-Term Workforce Plan is not fully funded because no Parliament can bind another. See also the IFS, Kings Fund and Health Foundation analyses for the evident gaps in the plan.

It is sub-optimal for there to be such blatant, massive and easily-spotted lies in the new Health Secretary’s first speech.

O’Brien and Quince step down

It is a political sign of the Conservative And Unionist Party’s times that two competent health ministers both chose to stand down in the reshuffle. It denotes the growing certainty among members of the political Reality-Based Community that the ‘natural party of government’ is going to spend a chunk of time remembering what it’s like in opposition.

This has re-opened the ministerial door to former Tory leadership contest finalist Andrea ‘Speaking As A Mother’ Leadsom

and to Pendle MP Andrew Stephenson.

McKinsey have the answer (to the question ‘name a Big Four management consultancy firm?’)

NHS failing to improve despite rise in budget and staff

The NHS has opened a review into why it is treating no more patients than before the pandemic despite having higher budgets and more staff

The TimesChris Smyth, Whitehall Editor

NHS England have called in McKinsey to discover why the extra resources that have gone in have not been matched by increases in NHS productivity, as Chris Smyth of The Times reveals.

In a careful bit of language, Chris reports that “The Treasury did not order the review, but has welcomed it”.

Why is Mr Hunt doing, sorry, ‘encouraging’ this now?

Hunt’s productivity review has the NHS in its sights

Ed Jones explains how the chancellor’s Productivity Review aims to reshape the NHS, addressing fiscal challenges and unlocking transformative changes to enhance efficiency, quality, and long-term productivity in healthcare services

Health Service JournalEd Jones

Mr Hunt’s former special advisor Ed Jones’ piece in Health Service Journal offers us some clues. Ed writes that “the Productivity Review targets an additional 0.5 per cent of savings across the public sector through progress in three workstreams – prevention, AI/digital, and administration … For NHS audiences, it will attempt to provide solutions to the ambitious labour productivity assumption of 1.5–2 per cent contained in the Long Term Workforce Plan …

“NHS budgets will not fall, but the NHS is by no means insulated from this review simply because of its arm’s length governance, operational complexity, or political resonance ... The NHS is firmly in its sights (and with almost £170 billion of public money at stake, it has to be).

“The review’s significance for healthcare services may be judged in three ways. First, it will select specific operational transformation priorities for political and financial backing. Second, it will influence the political debate on overall public spending levels (for whoever is in government). Third, and most significant, it offers the chance to overhaul how the Spending Review process itself works, thereby providing public finances with far more flexibility to deliver up-front investments in schemes which genuinely and demonstrably boost productivity.”

It is, nonetheless, delightful to see the Chancellor rediscovering the value of managers and management.

Far from the end of Sunak’s woes

The Conservative And Unionist Party’s media stenographers have convulsed with delight about the return of former PM David Cameron, who is to be kicked upstairs and made Foreign Secretary.

Given that Mr Cameron took the country in to the disastrous war in Libya and fought and lost the wholly unnecessary Brexit referendum hoping to resolve his own party management problems, I find their optimism charming.

But Leaky Sue-Ellen Braverman - lest we forget, a woman clueless and daft enough to have been fired by incompetence poster-girl and (oh yes, she really was) Prime Minister Liz Truss - seems un-inclined to take her sacking meekly.

To trigger a leadership challenge, Braverman would need 15% of the current CAUP Parliamentary Party to support her with letters of no confidence: 54 MPs. She probably doesn’t have that number, and the level of vitriol she deploys in her letter may dilute potential support in any leadership bid she might stage following electoral defeat.

Given their demography, it seems remarkable that only 21% of self-identified Conservative supporters told the Ipsos Issues Index that ‘NHS/hospitals/healthcare’ was the most important issue facing Britain today.

Speaking of Ipsos, their latest Political Monitor finds that “75% of Britons disagree that in the long term the government’s policies will improve the state of Britain’s public services”. This is the highest figure to be critical of the government’s long-term policies for public services since the Ipsos series began in 2001. One has to wonder where the other 25% of respondents sampled are living.

We learn that among those surveyed, “78% currently think the quality of public services has got worse over the past five years (including 70% of Conservative supporters). This compares to 63% who said the same in March 2017 ahead of the General Election later that year, and 40% back in November 2012.

“Looking forward, expectations for the future of various aspects of life in Britain are also on balance pessimistic, and all have got worse since February 2020.

“In particular, 64% expect the NHS to get worse over the next few years (up 18 points since February 2020, similar to the previous worst score of 62 per cent in March 2017).”

Ooops.

Providers in peril?

State of the provider sector 2023

NHS Providers launched their ‘State Of the Provider Sector 2023’ annual report ahead of their annual conference this week.

It’s not telling you much that’s surprising: it’s a set of statements of the obviously real, but it’s still a stark read. “Over three quarters of trust leaders (76%) said it was very unlikely or unlikely that their trust will end 2023/24 in a better financial position than it ended 22/23 … Eight in 10 trust leaders (80%) strongly agreed or agreed that winter 23/24 will be tougher than 22/23.

“Most trust leaders were extremely or moderately concerned about the current level of burnout (84%) and morale (83%) across the workforce. Most (78%) were very worried or worried about whether their trust has capacity to meet demand for services over the next 12 months, a higher proportion than before the pandemic in 2019 (61%).

“Over two fifths (41%) rated the current quality of healthcare provided by their local area as very high or high. Less than one third (30%) predicted that the quality of healthcare provided in the coming two years would be very high or high.

“Trust leaders strongly disagreed or disagreed that their trust will have access to sufficient capital funding for example, to: transform and continue the journey to digital maturity over the next three years (63%), invest in business critical ICT infrastructure or systems (60%), or address the maintenance backlog (high or significant risk issues only) (70%).”

Amanda Pritchard: you wouldn’t know increased NHS productivity - it goes to another school

Parliamentlive.tv

Health and Social Care Committee

Health and Social Care Committee

In a moment to inspire a battered and weary health policy nation, NHS England’s chief executive Amanda Pritchard told the Commons Health Select Committee on Tuesday morning that of course they could see the increase in NHS productivity, if only they’d just believe in it a bit harder.

I paraphrase slightly, but not by much.

The Tinker Bell productivity gain was described by Pritchard thus: “There is a misunderstanding at the moment about the state of productivity in the NHS because it’s measured in a way which doesn’t fully reflect either what happens at acute trusts … or, crucially, it doesn’t reflect what’s happening in community care, it doesn’t count things like virtual wards.

“And it doesn’t reflect some of the innovation in the ways that we have evolved services to the benefit of patients in using technology.

“If you take into account of all of those things, actually the start point is an NHS which is doing far more work and differently than it was pre-covid. [That] doesn’t mean there aren’t still productivity challenges but it’s just a very different baseline on which to build.”

Is there really an NHS productivity crisis? | Institute for Fiscal Studies

It is difficult to measure NHS productivity. But the available evidence strongly suggests that the NHS is less productive now than pre-pandemic.

Institute for Fiscal Studies

The Institute for Fiscal Studies’ health team of Ben Zaranko and Max Warner bit back at the magical thinking involved, in this piece, highlighting their previous work.

And the Health Foundation’s Charles Tallack spotted that the Office for National Statistics has released its latest estimates of NHS productivity: it suggests that productivity is 5.5% below the pre-pandemic level.

Public service productivity, UK - Office for National Statistics

An overview of UK annual public service productivity between 1997 and 2020, and a new experimental measure for the path of annual UK public service productivity in 2021 and 2022.

Office for National StatisticsEd Bailey, A Blunden, Nick Chapman, Rebecca McAlpine

Ooops.

Streeting promises NHS league tables and turnaround teams

League tables for NHS under Labour’s ‘reform or bust’ plan

Wes Streeting will promise ‘far more transparency’ about poor performance and no more ‘turning a blind eye to failure’

The TelegraphLaura Donnelly,

Writing for the Boris Johnson Fanzine, Labour’s shadow health secretary Wes Streeting previewed his speech to the NHS providers conference by promising a return for explicit provider league tables.

Both made a much smaller contribution to the 2000s NHS improvements and reforms than the national tariff, payment by activity and FT surplus retention.

In his speech, Mr Streeting also vowed to enforce a duty on GPs to offer patients choice. It is frankly unclear what this will mean in a system that desperately lacks spare capacity, not least in primary care and among GPs.

In his speech, Mr Streeting also compared current NHSE chief executive Amanda Pritchard to Louis XIV.

Editorial Thursday 14 August 2015: Journey To The Foot Of Our Stairs - on the Tories’ offshoring health policy to Simon Stevens

If it hasn’t been done already, the socio-cultural impact of classic phrases from Lancashire is undoubtedly a PhD thesis waiting to happen. Lancastrians are a withering lot, which presumably you need to be if you’re going to fight people from Yorkshire about flowers [https://en.wikipedia.org/wiki/W…

Health Policy InsightMr Andy Cowper

Lese-mejeste, innit. This was, of course, my line about Simon Stevens being ‘The Sun King’ - less because of “l’etat, c’est moi”, and more because of “laws are the sovereigns of sovereigns” and “it is legal because I wish it”.

The NHS, Stockholm Syndrome and the Treasury

NHS trust: why Whitehall’s increasingly divided view on health and care matters

With Whitehall paymasters showing less faith in the organisations that hold the budgets for health and social care in England, Mark Dayan describes five ways that such tensions behind the scenes can impact on the running of services.

Nuffield TrustMark Dayan

This new piece by the Nuffield Trust’s Mark Dayan on the relationship of distrust and non-delivery between our dearly beloved chums the Treasury Munchkins and the NHS, the Department For Health But Social Care and its wholly-owned subsidiary NHS England reminded me of my main observation at this year’s Nuffield Trust Summit: that all health policy debates essentially now happen on Treasury turf of return on investment.

Editorial Wednesday 23 November 2016: Stuck outside the Treasury with the funding blues again

Well. Wasn’t that a bracing few weeks? Let’s start with the money, shall we? NHS Improvement’s Q2 financial report shows the NHS provider sector gamely struggling its way back towards financial balance [”https://improvement.nhs.uk/resources/quarterly-performance-nhs-provider-sector-quarter-2-1617/]…

Health Policy InsightMr Andy Cowper

I have written previously on the Treasury mindset, and its impact on developing a mature relationship with the NHS.

Cowper’s Cut 259: The illusion of control

“There is no version of reality whereby “several million people will receive the vaccine before Christmas” so whoever briefed that might want to urgently undertake some course correction before that inevitably becomes clear...” NHS England chief executive Simon Stevens, WhatsApp group message, 13 D…

Health Policy InsightMr Andy Cowper

It is narcissistic to quote oneself. Still, it’s only being so wonderfully modest that keeps me going, so here we go (again): “I was struck by the framing of almost every question and comment from the floor on the first day being around 'the business/economic/financial case' for this or that.

“It may not quite realise it yet, but the NHS policy community is now in a Stockholm Syndrome relationship with the Treasury mindset: as such, it is arguing on Treasury intellectual and philosophical turf - which frankly will neither help nor work.”

Still, this week saw some rare good news for fans of financial transparency: Lawrence Dunhill and colleagues from HSJ successfully pestered NHS England into publishing fairly up-to-date financial performance for local trust and ICSs.

The data is here. This is excellent work.

It was daft of NHSE not to have held their own and the system’s feet to the fire in this way years ago, mind. Still, transparency improvement is improvement, and we must take it where we can.

The Alan comeuppance

The People’s Partridge has been curiously silent this week. Girding his giblets for his upcoming appearance at the Covid Public Inquiry, perhaps.

Recommended and required reading

Fine piece by David Oliver for Byline Times on the longstanding crisis in social care.