Cowper’s Cut 331: Getting broken with tough love from Wes Streeting

“Our love for the NHS is not in doubt. But sometimes, if you love someone, you have to force them to change … (DHSC) is no longer simply a public services department: this is an economic growth department. The health of the nation and the health of the economy are inextricably linked.”

Wes Streeting, Secretary Of State For Health But Social Care, ‘Future Of Britain’ Conference 9 July 2024

Health Secretary Wes Streeting kept up a high pace in his first full week in the role.

His appearance at the 2024 ‘Future Of Britain’ Conference (Blairstock) saw him eschew a speech for a Q&A with event co-chair John Sopel.

Mr Streeting reiterated his point about the Department for Health But Social Care being “no longer simply a public services department: this is an economic growth department”. It’s an interesting corollary to his remarks on day one in office about DHBSC policy henceforth being that the NHS is “broken”.

Pasty of the purpose of all of this week’s political events is framing matters to pin the blame for the state of the NHS in 2024 inevitably and squarely on the previous Conservative And Unionist Party governments.

So far, so obvious … and perfectly sensible politics. It is a returning of the favour that George Osborne led in 2010, in attributing the UK’s ‘need’ for the political economics of austerity that dominated that decade solely to Labour’s overspending in office: the ‘maxing out the nation’s credit card’ nonsense.

What is salt for the wounds of the goose is salt for the wounds of the gander.

What this discourse signally fails to do is provide us with many clues about what the new government intends to do about the appalling state of the service and system. This is messaging as political choreography: it’s not unimportant, but it’s not the real point either.

There is essentially one important question, from which we shouldn’t get distracted: who is going to write the music of the parallel processes of

1. Performance recovery
2. A return to management
3. System moving towards prevention

Two experts join DHSC to lead 10-year reform plan

Two health policy experts are joining government to help draw up a 10-year plan for health.

Health Service JournalHenry Anderson

We also learned this week that Professor Paul Corrigan and Kings Fund director of policy Sally Warren have been recruited to write an NHS 10-year plan. You do need a ten-year plan, because you need an objective. ‘We’re going over there’.

What has been completely undiscussed is how a Labour Government will go about 1, 2 and 3 above.

And it is really important.

There is, however, something unhelpful about Mr Streeting’s ‘tough love’ analogy that “sometimes, if you love somebody, you have to force them to change”. This might be a useful analogy if the main problems for the NHS was that it were addicted to drugs or alcohol. Since it is not, it comes across as an unhelpful dose of Milburnian machismo.

Mr Streeting is not a stupid man, and he should already be aware that he will get far further faster with the NHS stakeholders whom he needs onside by reasoned persuasion than he will by explicit or implicit threats.

If he is not yet aware of this, it will be telling to see how soon the penny drops.

It was a busy day: Mr Streeting also had his first in-person meeting with the BMA junior doctors committee leadership. There were positive statements issued from both sides.

The Darzi Re-Review

For those of a certain vintage, the Darzi Review meant High-Quality Care For All. That’s so 2008, baby: it now means the noble Lord’s Independent Investigation Of NHS Performance: a new independent review, whose terms of reference are here. It is to report by September.

(This DHBSC clip for Twitter has very weird jump-cuts throughout: somebody is a wannabe film studies graduate, who needs to watch ‘Stagecoach a few hundred more times.)

Our NHS needs reform... before we write prescription we’ll diagnose problem

IT’S clear to anyone who works in or uses the NHS that it is broken. Patients are waiting more than a year for an operation. They cannot get through the front door for a GP appointment. And when th…

The SunWes Streeting, Secretary of State for Health & Social Care

Mr Streeting announced this in The Sun.

Once again, this is best understood as political choreography. The likelihood that Lord Darzi of Denham will have revelations about the NHS’s poor performance that the major health and other thinktanks seems scant.

The point here is the brand: Darzi is an eminent surgeon. He has also been linked to the tech-utopian visions for NHS reform of the Tony Blair Institute For Global Change: this too will sit well with Brand Streeting.

This choreography is probably necessary for the political spectacle, but the relevant question is who is writing the actual score.

Later in the week, Mr Streeting gave Channel Four News’ Cathy Newman an interview in which the political rhetoric got even sharper: he deemed the NHS to be “going through what is objectively the worst crisis in its history”.

This is fine, insofar as Mr Streeting wants people to start asking the question of how and why he leaves in place the NHS leadership that compliantly nodded along with much of this serious degradation (consistently claiming to be doing jolly well, all things considered).

That is a much more challenging question.

Exclusive: Streeting has ‘total confidence’ in Amanda Pritchard

The shadow health and social care secretary has “total confidence” in NHS England chief executive Amanda Pritchard, he has told HSJ.

Health Service JournalJames Illman

But of course Mr Streeting has “total confidence” in Amanda Pritchard.

The art of the unanswered question

Sometimes, the questions you don’t answer are telling.

The Spectator’s Isabel Hardman, following a Q&E with Prime Minister Sir Keir Starmer, reports that the PM asserted that Mr Streeting’s “broken” line was not aimed at NHS England boss Amanda Pritchard. Isabel also notes that the PM did not answer a follow-up question about whether he will keep Mrs Pritchard in her current post.

Streeting announces DHBSC & NHSE to work together

Streeting tells NHSE and DHSC to ‘work as one team’ and air ‘competing views’

Wes Streeting has told his department and NHS England to work as “one team” to improve services - which includes relaying their “competing views and interests” to him.

Health Service JournalZoe Tidman

Health Service Journal obtained a read-out of Mr Streeting’s first online briefing to NHS England and DHBSC staff. It offers clues to what a Streeting style of working in office may prove to be.

He told staff, “we will only succeed in turning the NHS around by working as one team. This government has been elected on a platform that said the NHS was broken and it needs to change. It will take time to fix it, and it will only happen with a team effort.

“That means I expect joint submissions from NHS England and the department, collaborative team working across both organisations, and again, where there are sometimes competing views and interests, I want that relayed to me, too.”

“ … Given we are grappling with some enormous challenges that involve difficult choices and trade-offs, where there are contested views in different teams … I want to hear a range of views and opinions.”

This is reasonably reassuring stuff. This is, of course, just his early words: they are yet to collide with reality.

Mr Streeting’s first visit in office

It is being regarded as telling that Mr Streeting’s first visit was to the London GP surgery where Mail On Sunday columnist GP Dr Ellie Cannon practices.

The new ministers: Stephen Kinnock joins Gwynne, Merron and Smyth

A cross-party Royal Commission on social care? Ambassador, you are spoiling us!

I wish this were satire, but apparently there may be a real prospect of a new cross-party Royal Commission on social care, according to The Times’ Chris Smyth.

Labour plans cross-party royal commission to fix social care

Although unlikely to be included in the King’s Speech, by announcing a review Keir Starmer is hoping to capitalise on his election landslide to tackle vexed issue

The TimesChris Smyth, Whitehall Editor

Because 1999’s went so well.

As did the last decade’s Dilnot and Barker Reviews.

It turns me into a bit of a cross party. Any such move would be blatant displacement activity. What is needed on social care is action. What is potentially coming is simply more long grass, of the kind you can’t even smoke.

Latest English NHS performance data: still bad

The latest RTT data for the English NHS showed almost 30,000 more added to the RTT backlog, and the tragets on 15, 18 and 24 month waits all still being missed.

Wait list and wait times worsened again in May

A worsening situation in the penultimate waiting times data for the outgoing Conservative government

Health Service JournalRob Findlay

Rob Findlay’s usual excellent analysis is here.

NMC independent culture review

The Nursing and Midwifery Council’s independent culture review by Nazir Afzal was published, and could scarcely be more damning. Its conclusion states, “there are also a growing number of staff who are trapped in a dangerously toxic culture and feel deeply frustrated and upset in their jobs. And it’s this latter culture that is starting to overwhelm the good work and do enormous damage.

“The origins of this review lie in claims of a toxic culture made by a whistleblower last year. The reported claims of racism, people being afraid to speak up and nurses accused of serious sexual, physical and racial abuse being allowed to keep working on wards were all repeated to us on multiple occasions.

“Everything the whistleblower documented was corroborated and we spoke to many others that had similar experiences. On reflection, given these patterns, it’s remarkable that there have not been more whistleblowers coming forward.

“Previous reports show that this toxic culture has a long history at the NMC, but while it might have previously been contained, our concern is that it is now widespread”.

EveryGrifter: still here, unfortunately

Emetic EveryGrifter boss Dr Julia Grace Patterson, fierce campaigner against fictional NHS privatisation, is back, alas.

She has launched a campaign to ‘rebuild the NHS’.

Mmmmmmmm.

I wonder whether it involves giving her money?

Recommended and required reading

New Nuffield Trust piece shows that the English NHS is doing particularly poorly in recovering median surgery waiting times, by international comparisons.

Former Vaccines Taskforce lead Dame Kate Bingham calls for a similar approach to drugs for Alzheimer’s and dementia.

Professor David Oliver’s latest Byline Times column.

The Briefing Room on AI in healthcare.

BBC News notices the NHS non-productivity conundrum.

Via Steve Black, a frankly magnificent and sweary blogpost about how and why almost all the claims for AI are hyperbollocks. Tony Blair won’t like it.

You know I mentioned last week how private providers offload their old, needing-work facilities onto the unwary?

Hurrah! The politcians are back in control

The NHS has issued a statement expressing support for Wes Streeting as the new health and social care secretary promises to take back control, get the NHS done and lead us to the sunlit uplands. Julian Patterson has the details

Health Service JournalJulian Patterson

Julian Patterson’s latest HSJ column is brutally magnificent.