Sep 8, 2024 7 min read

Cowper’s Cut 339: The Great British Lord-Off - Darzi vs Lansley. Seconds out!

It seems that this week will end the post-election ‘Waiting For Darzi’ era.

The briefing of the nationals began in earnest, with The Observer treated to a ‘blame preview’, which fingered the Tory health reforms as having left the NHS wider open to the impact of the Covid19 pandemic than comparable European neighbours.

The leaked material sees the noble Lord Darzi of Denham conclude that NHS “routine healthcare activity fell by a far greater percentage than other health systems” in many key areas during the Covid crisis.

The Observer’s James Tapper and Toby Helm report that NHS hip and knee replacements fell by 46% and 68% respectively. Hospital discharges as a whole dropped by 18% between 2019 and 2020 in the UK, as compared with the Organisation for Economic Co-operation and Development average of 10%.

Operation Blame Lansley

Lord Darzi will also assert that the NHS is still suffering the aftereffects of its inability to respond adequately to the Covid shock at the time: “the state of the NHS today cannot be understood without recognising quite how much care was cancelled, discontinued, or postponed during the pandemic … the pandemic’s impact was magnified because the NHS had been seriously weakened in the decade preceding its onset.”

Lord Darzi reportedly goes further, with the claim that the Lansley reforms “scorched the earth for health reform”.

“The Health and Social Care Act of 2012 was a calamity without international precedent – it proved disastrous. The result of the disruption was a permanent loss of capability from the NHS … This is an important part of the explanation for the deterioration in performance of the NHS as a whole.

“Rather than liberating the NHS, as it had promised, the Health and Social Care Act 2012 imprisoned more than a million NHS staff in a broken system for the best part of a decade.”

Does dear old Lord Lansley accept this critique? Everyone informed knows that (as I keep banging on about) the Lansley Liberation cut NHS management by 45% of the 2008-9 level.

But in the finest traditions of ‘Equity And Excellence: Liberating The NHS’, Lord Lansley told the Observer journalists that he was absolutely right and Lord Darzi was completely wrong. Warms your heart, doesn’t it? It’s just like 2010-12 deja vu, all over again.

Like the NHS, political nostalgia isn’t what it used to be.

Dear old Lord Lansley defended his reforms, saying Darzi should be focusing on the “here and now” rather than reaching back over a decade for a “blame the Tories” narrative: “the 2012 act created NHS England. It empowered the NHS. It reduced administration costs by £1.5 billion. Waiting times fell to their lowest level. The longest waits were virtually eliminated”, Lord Lansley bid. He also told The Observer that if his plans had been fully implemented, they would have made the NHS more internationally competitive.

One must have a heart of stone not to laugh at Lord Lansley’s clue-deficiency about the current operational and reputational state of NHS England.

The noble Lord Lansley’s chutzpah in claiming that the eradication of long waiting in the NHS over the 2000s was anything to do with his catastrophic reforms (so unpopular that they had to be stopped in their passage through Parliament, as my fellow ‘Pause’ fans remember) is almost impressive.

But not quite.

I do recommend that anyone wanting a picture of how much of a mess health policy and politics have been in this past fourteen years re-read the report of the ‘pause’-born NHS Future Forum. It is really remarkable how not one little bit of its recommendations for improvement happened at all in the NHS in the real world: not even slightly.

But I’m sure there’s an absolutely splendid parallel NHS driven by patient choice, competition and clinical commissioning in the parallel universe of LansleyLand. And no doubt everything is going spiffingly there.

There is no way to be polite about this: I have shat things more credible than the noble Lord Lansley’s assertion that he left the NHS in good shape and that his reforms did not lead to the downfall of the NHS over the decade from 2010-19.

It is ahistorical nonsense.

Under-managed, you say?

Health Service Journal’s Nick Kituno had the first leak on the Darzi Review content - it is expected that the review will (unsurprisingly) find that the NHS is under-managed. The more interesting issue is what the New Darzi Review will suggest that system leaders should do about this.

The HSJ piece cites “one trust CEO who had been briefed by the review team said it would “highlight low manager and leader numbers compared to other health services” – a message, they predicted, that the government “won’t want to hear”.

“Another well-placed source said the review was likely to make clear that the NHS needed to invest more in good management, particularly in managers with the right skills and capabilities, and that it should not use reduced management costs as a barometer for success”.

It also cited “several well-placed sources (who) said they had been told the review would highlight that the NHS was underfunded compared to many other health systems, with its budget severely constrained in recent years despite steeply rising prices”.

As Nick points out, “that jars with comments from Mr Streeting and his advisors stating the NHS doesn’t need more funding; and with a very tight public spending round in the 30 October budget”.

HSJ’s Matt Mathers reported that Health Secretary Wes Streeting told a gathering of senior NHS managers early this week that he would blame the Tories for this coming winter’s nailed-on NHS crisis, but that (in one attendee’s words) “thereafter it’s our fault”.

The key message at this meeting from Team Streeting was that there is no more money coming for this winter. Which is rational enough, given that there is no time left to spend it on anything meaningful. As I wrote last week, lead times are A Thing.

Thoroughly Modernising Milly

The Sunday Times’ Shaun Lintern and Gabriel Pogrund have a cracking story about the return of Alan ‘Bouncer’ Milburn. It seems that ‘Bouncer’ has been attending regular meetings in the Department For Health But Social Care and NHS England, without having any actual official role (yet).

This has got up the nose of some civil servants, it would seem. The ST piece states that Milburn “was in the department’s Victoria Street offices every day during a so-called “focus week” running from August 12. He has also had discussions with NHS England officials over the NHS long-term workforce plan and efforts to improve NHS productivity.

“Milburn has had access to sensitive documents in printed form because he does not have a government email account or access to internal systems … (and he) was also present at a dinner between Streeting and Lord Darzi of Denham on Wednesday night prior to the publication this week of the peer’s review of the NHS”.

Bob The Whippet’s Emotional Support Human and Shadow of her former self Victoria Atkins was hoping to make something of The Milburn Return on Sky News’ Trevor Phillips Show.

This really won’t wash: people might start pointing out that Tory Health Secretary Matt ‘Alan’ Hancock put his actual lover Gina Coladangelo on the DHBSC board, and conducted his affair with her in work time and in the DHBSC offices.

Which are, doubtless, an erotic hothouse.

Operation Blame Lansley

Under-managed, you say?

Thoroughly Modernising Milly

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