Cowper’s Cut 329: The 2024 General Election health policy debate - almost as good as England’s football

Ahem.

Ahem-ahem.

I wrote some weeks ago about the ridiculousness of the classic NHS narcissism of temporary NHS England chief executive Amanda ‘Scrapyard’ Pritchard’s claim in her message to the service asserting that “the subject of the NHS will be front and centre in the election campaign - as it always is”.

I have, once again, not been wrong.

The NHS has not been the subject of serious debate or discussion over the past six weeks. We know very little (other than headlines and vibes) about Labour’s detailed plans for NHS reform. This is probably because they don’t have any, but if they do, they have been subjected to zero public scrutiny or consideration.

That omission is probably going to be important, come Friday.

Ah well. They will learn the hard way, it seems.

Health minister Lord Markham hired friend to work on New (If Fictional) Hospitals Programme despite civil servants’ warnings and with no tender

Tory minister accused of cronyism after associate’s firm hired as adviser

Civil servants raised objections to health department giving contract to company run by close associate of Nick Markham

The GuardianDenis Campbell

It’s hard to imagine how the Conservative And Unionist Party’s general election campaign could be going much worse. The news coverage of their insider trading betting on the date of the vote may mean that this story gets less attention than it should.

This FOI-based story in The Guardian followed up on Health Service Journal’s findings from last year about the use of an external consultancy in the Government’s New (If Fictional) Hospitals Programme.

It reveals that “Nick Markham helped to ensure that the Department of Health and Social Care handed a £137,460 contract to iDevelop, a management consultancy run by Nigel Crainey. In doing so, he overrode concerns from civil servants who had warned that the contract was not needed and did not represent value for money, and also that the two men’s relationship meant that it posed “reputational risk” for the department and the NHS.

“Asked by NHS England what the basis was for engaging iDevelop to be an “expert adviser” to Lord Markham, a senior official in the DHSC’s new hospitals team replied: “Because we have been told to.”

“Detailed communications between the DHSC and NHSE, obtained under freedom of information laws, show that Markham appears to have ignored major disquiet among his own officials and insisted that the contract go to his associate. There was no formal tendering process.”

The story cites emails showing that then-SOS Steve ‘the Banker’ Barclay “approved the contract despite officials’ objections”.

When Labour are in Government in a week’s time, this should be added to the already-tall pile of dubious procurement decisions for investigation.

Mordaunt: we should have resolved junior doctors’ pay row

We should have resolved junior doctors strike, admits Mordaunt

In a leaked recording, leader of the Commons said the only way to end the junior doctors’ strike was by discussing pay

The TimesAubrey Allegretti

Leader of the House Of Commons and sword-wielder Penny Mordaunt MP told a hustings event that the backlog-exacerbating strikes should have been avoided through pay negotiations with junior doctors.

A recording of the event captured her words: “I wish we had resolved that, because it would have made a big difference to waiting lists. The only way we resolve that is by getting round the table and discussing pay.”

Wes Streeting: new think-tank data shows primary care collapsing. Also Wes Streeting: think-tanks do health establishment complacency and groupthink

Wes Streeting: The GP system is on brink of collapse

Shadow health secretary says Labour will divert money from hospitals to family doctors to fix ‘front door’ of the NHS

The Telegraph

The health policy nation’s favourite Alan Milburn tribute act, shadow health secretary Wes Streeting, has been at it again.

Is Labour’s remedy for the NHS to turn back the clock?

Architects of New Labour’s reform success prescribe fresh approach to fit the times

It was a timely week for it, as this Financial Times feature picked up on the ghosts of New Labour currently haunting the present Labour leadership (Milburn, Paul Corrigan and Peter Hyman are all namechecked). ‘Cut’ readers have, of course, known for a long time about Milburn’s mentoring role for Streeting.

In the wake of the latest Health Foundation GP data dashboard update, Mr Streeting did a set-piece interview with the Boris Johnson Fanzine pledging to divert billions of pounds from hospitals in an attempt to save primary care: “the front door” of the NHS.

He also vowed to be “far more assertive” in questioning how the £170 billion NHS budget is spent, and shifting far more resources into services in the community. Streeting told the BJF that “I genuinely think general practice is on the brink of collapse” and pledged to “bring back the family doctor … (and) rebuild the relationship between GP and patient”.

From where will these extra billions for primary care come? What is to be defunded, to fund this?

Mr Streeting does not say, or was not asked.

Milburnically touchy about being challenged

How much spending on the NHS have the major parties committed to in their election manifestos?

To help inform the debate around the imminent general election, this explainer looks at the manifesto commitments that have been made on NHS spending by each of the main parties. How do they stack up, and what would it mean in practice for the NHS budget in coming years if their commitments were enacted?

Nuffield TrustSally Gainsbury

He is Milburnically touchy about being challenged, addressing the recent Nuffield Trust critique that none of the main parties’ health plans are candid or clear: “during this election campaign, we’ve taken some flack, particularly from the think tanks, because Labour doesn’t have a big spending manifesto when it comes to health.

“But I think - and I say this with respect, that think tank analysis speaks to the breathtaking complacency and groupthink, amongst the health establishment who think that the first answer is always more money, without first questioning how almost £170 billion of taxpayers’ money has already been spent.

“You talk to the patients who are using the system, the staff working in the system – they can see examples every day of waste, inefficiency and bureaucracy.”

The French paradox

Now clearly, Streeting, our someone from his party (remember Chris Smith didn’t get the job when moving from opposition in 1997, though that was more about internal Labour politics) will be the next Health Secretary with a huge majority - likely to be in the hundreds.

That will give him yet more self-assurance that he can go into battle without the health establishment / thinktanks onside. He may even channel US under-secretary of defence Jed Babbin’s famous line (on the 2003 Gulf War) that “going to war without France is like going deer hunting without an accordion: you just leave a lot of useless, noisy baggage behind”.

Well, Mr Streeting has a lot of thoughts. One of them, in his Sunday Times interview which is covered below, is that “I want to create a culture from the very top where people can be honest with me when things are going wrong, or they think I’m making a bad decision”.

Challenging views: good, apart from when bad

So Mr Streeting thinks that listening to challenging views is good, except for when it’s bad. It’s helpful that we’ve got that nice and clear.

He also hints at a prompt deal on junior doctors’ pay: “This dispute has meant over a million operations appointments and procedures being delayed or cancelled and it has cost the taxpayer £3 billion – that is a hell of a lot of money to pay for failure.

“So it is in our interest to cut a deal and we’re going to have to look at what we can do as far as the books allow”. Stressing that 35% in one go is “not something that the country could afford”, he also lauded the BMA JDC leadership’s “willingness to negotiate down from 35 per cent to recognise that pay restoration is a journey, not an event. I think we can find a deal in that space”.

Labour confident of ending doctors’ strikes after secret talks

Agreements in Wales and Scotland raise hopes for post-election pay deal in England

There is further authentic-looking intel on this briefed by the BMA to the Financial Times, which reports that “meetings between shadow health secretary Wes Streeting and the British Medical Association in recent weeks, including once during the campaign, have raised hopes that a deal can be reached to end the two-year industrial dispute, people close to the discussions said.

“… Labour offering a one-off bonus or an agreement to raise doctors’ pay over several years could finally break the deadlock.”

BMA judicial review a new nail in the coffin of failed steamroll-out of MAP roles

British Medical Association chair of council Dr Philip Banfield announced at the trades union’s annual representative meeting that the BMA has launched a judicial review of the General Medical Council over its decision to apply good medical practice equally to physician and anaesthetic associates (PAs & AAs), and of its use of the words “medical professionals” to describe these professions.

‘Cut-price doctor’ physician associates and anaesthesia associates acting illegally in one in eight NHS trusts

Physician associates and anaesthesia associates have been found to have acted illegally in one in eight NHS trusts, LBC has uncovered.

LBCHandyMan_18

A freedom of information study of 50 NHS trusts by LBC found that one in eight respondents reported that AAs/PAs had breached legal guidelines in their practice.

Streeting promises whistleblower protection and manager regulation

Wes Streeting: I’ll protect NHS whistleblowers and sack rogue bosses

The health secretary in waiting outlines Labour plans to end what he sees as a toxic culture of cover-up

The Sunday TimesShaun Lintern, Health Editor

Labour’s shadow health secretary Wes Streeting told The Sunday Times’ Shaun Lintern that he plans to address the NHS culture of concealment and whistleblower harassment.

Streeting suggested that the contaminated blood disaster, Lucy Letby’s serial killing and the many failure of maternity services, show that the NHS prioritised protecting its reputation over patient safety.

“That cannot be allowed to continue. We cannot have a culture where whistleblowers are not only afraid to come forward, but where they do, they are actively silenced.” These comments clearly draw on the Messenger/Pollard Review’s active criticisms of NHS management culture.

He also clearly plans to build on the recommendations by Sir Robert Francis’ Mid-Staffs Public Inquiry and the Kark Review for registration and regulation of NHS managers.

So far, so potentially promising, although as Paul Corrigan’s blog on the topic last October noted, the regulation of managers will not be a quick fix.

But there is a strange section about how to improve clinical leadership. That is a noble goal, but for some reason, Mr Streeting thinks that the answer is a Royal College of Clinical Leadership “to help doctors and other clinicians transition to management roles”.

This notion that Royal Colleges are sure to succeed at this challenging task is optimistic (and the RCP’s recent travails over its gerrymandering attempts to support the steam-roll-out of physician associates should offer a salutary lesson).

‘Let’s create a new Royal College to solve all our problems’, said nobody, anywhere, ever. This is widely perceived as being a response to lobbying from the Faculty of Medical Leadership and Management, which is perceived as willing to self-identify as a royal college.

CQC boss quits amid evident failure

In a wholly unsurprising way, Care Quality Commission chief executive Ian Trenholm stepped down with near-immediate effect in the week of the Channel Four Dispatches documentary on the appalling emergency care at the Royal Shrewsbury Hospital.

The Dispatches programme also triggered another brilliant intervention from NHS England, telling trust leaders that corridor care must not become the norm. The NHSE letter warned that corridor care “should only be in periods of escalation and with board-level oversight at trust and system level … where it is deemed a necessity … it must be provided in the safest and most effective manner possible, for the shortest period of time … with patient dignity and respect being maintained throughout.”

So that’s helpful.

Exclusive: CQC admits it is failing to keep patients safe

The Care Quality Commission has admitted it is failing to keep patients ‘safe’ and is losing the confidence of ministers and the NHS, HSJ has discovered.

Health Service JournalEmily Townsend

This was promptly followed by an outbreak of media-leaked honesty: Health Service Journal obtained an internal CQC ‘problem statement’ document, which was spectacularly damning. Interim chief executive Kate Terroni‘s review says that “stakeholders and the Department of Health and Social Care are losing confidence in our ability to deliver our purpose.

“The way we work is not working and we are not consistently keeping people who use services safe. Our people are not able to effectively identify and manage risk and encourage improvement and innovation.

“Our organisational structure, flow of decision making, roles, internal and external relationships do not promote a productive and credible way of working.”

So that’s just about everything the CQC do not going terribly well.

The CQC’s reputation has been in serious decline for many years now, even allowing for the fact that an independent(ish) NHS quality regulator is not that likely to be well-beloved.

I have long been describing our current approach to inspection, oversight and regulation as like having a constellation of regulatory Death Stars orbiting the English NHS.

NMC appoint ex-NHS manager under cloud over employment dispute

Regulation, eh? The Nursing and Midwifery Council have made the entertaining decision to replace Andrea Sutcliffe, who stepped down for medical reasons, with Dawn Broderick.

The reliable Roger Kline and former Health Minister Ann Keen write that Ms Broderick “was the Chief People Officer at Kings College Hospital NHS in 2015-2020 when she would have been central to the Trust’s decision making in response to the race discrimination claim of Richard Hastings whose case was widely publicised in Too Hot To Handle”.

The CIPD journal People Management reported this case as follows (November 2018): “a former NHS trust manager who was unfairly dismissed and suffered racial discrimination has been awarded a reported £1 million by London South Employment Tribunal.

“Richard Hastings, an IT manager at King's College NHS Foundation Trust, was dismissed for gross misconduct in October 2015 after he was accused of assault following a dispute with a van driver in his workplace car park.

“The tribunal ruled the investigation into the incident was “fundamentally flawed” due to unconscious racial bias.

“It found that opportunities to collect further evidence to support Hastings’ claims of innocence were repeatedly missed and that Hastings – who was of African Caribbean origin – was treated less favourably than a white counterpart would have been. Investigators were said to have made up their minds about his guilt and only pursued evidence which would support this.”

Ooops.

The NMC’s statement in response to a question from the Sunday Times’ Shaun Lintern about whether they were aware of Ms Broderick’s track record spectacularly failed to say either yes or no.

Recommended and required reading

Channel Four ‘Dispatches’ documentary on dreadful A&E care.

Computer Weekly covers a group of NHS clinicians responsible for registries holding health information on millions of patients warning of the risk of a major data breach through the NHS England Outcome Registries Platform (ORP) project, which they claim has neglected basic IT security measures.

The Health Foundation’s general practice data dashboard.

BBC News cover the destruction of £1.4 billion worth of PPE from one single deal.

The Institute for Fiscal Studies’ Carl Emerson in The Times on why politicians’ manifesto financial NHS promises are meaningless.