Cowper’s Cut 340 (part 2): a post-Darzi update
I sent this week’s column early on the assumption that subscribers might prefer to have my fairly immediate assessment of the Darzi Review.
Mr Andy Cowper
So this is just a brief coda ‘hello’, touching on a couple of things.
Responses to Darzi
There have been some good ones. Nuffield Trust chief executive Thea Stein’s stood out for me for its consideration of culture and psychology, as did Craig Nikolic’s analytical thread of the report’s deficiencies and errors.
Isabel Hardman is always worth reading: ‘Policy Sketchbook’ also made some very good points about the broader context.
By complete contrast, Baroness Camilla Cavendish’s FT piece is quite opulently wrong.
I was invited onto The New European’s ‘The Two Matts’ podcast with the dynamic duo of Matt Kelly and Matthew D’Ancona, and we had a great chat, which you can find here.
PFI really may be on its way back
Patrick Maguire
I’ve touched in various recent columns on the prospect of a PFI comeback, and this Times coverage of this new report from the apparently influential Future Governance Forum suggests that ‘Infrastructure Investment Partnerships’ will be the new Private Finance Initiative.
IIP>PFI, in other words. Amazing what a bit of rebranding will do. Just ask Sellafield about Windscale.
Health Foundation autumn reception
I was pleased to attend the Health Foundation autumn reception, at which Health But Social Care Secretary Wes Streeting gave a concise and tonally well-judged speech. HSJ news editor Dave West summarised the few key points nicely here.
Introducing an inevitably late-running Streeting, HF chief executive Jennifer Dixon gave her job title as “chief executive of the NHS”. As slips go, this probably wasn’t Freudian.
But then in another sense, perhaps we are all chief executives of the NHS now?
The report found NHS activity has increased and there is a rise in the complexity of the care we provide too. This is also evidenced in today's stats showing we've just had our busiest summer ever, managing over 6.8 million attendances.
— Amanda Pritchard (@AmandaPritchard) September 12, 2024
➡️ https://t.co/dxBDBMfjjH
Somebody’s got to be. And the current incumbent Amanda Pritchard certainly isn’t: the many people who contacted me about the original draft of the Darzi Review were universal in their clarity that its initial draft was significantly harsher and more pointed about NHS England’s current lack of value, either in use value or ornamental terms.
Amanda lobbied Lord Darzi tremendously vigorously to get this emphasis reduced.
Those who got in touch were also consistently clear that the original draft of Darzi (which will doubtless leak) had a great deal, much more prominently-at-the-front of the document, about one of its four key themes: the big role of the Lansley reforms in screwing up the well-functioning 2010-bequeathed NHS.
Speaking of which …
The return of Lord Lansley
You can’t keep a good man down (or so the adage suggests).
Nor, clearly, can you keep Andrew Lansley down.
2010-12 health policy nostalgia is clearly A Thing in certain niche quarters.
Still, at least that reminds us of an era when we really knew what True Political Greatness looked like, eh?
Lord Lansley of Orwell has been infesting the national media letters pages since the Darzi Review was published with the awkward persistence of a fart in a spacesuit.
His argument (which will not be unfamiliar to those who recall my writings about Lord Lansley’s 2010-12 politics) is that he and his reforms were absolutely right, and everyone who criticises them or who didn’t implement them as he wanted is completely wrong.
I had, I must confess, not noticed that when he got ‘kicked upstairs’ to the House of Lords, Lord Lansley chose to be the peer of Orwell. That other Mr Blair, who took Orwell as his nom de plume, famously wrote that “political language … is designed to make lies sound truthful, and murder respectable, and to give an appearance of solidity to pure wind”.
Innit, though. Lord Lansley’s tottering out from the long horizon of irrelevance, to bring us the word from the mountain that he was absolutely right, and his opponents completely wrong, is indeed pure wind.
NHS England chief executive (the last time there really was one) Simon Stevens once described me as “the Nicole Kidman of health policy”, which gave us both (and quite a few other people) a reasonable laugh. In that same spirit, it seems fair to say that Lord Lansley is the Liz Truss of health policy: a person who just doesn’t begin to understand when it’s best for them to shut up and sod off, and stay sodded-off for ever.
If you saw the NHS as a puzzle with one single solution that only you could see, as Lord Lansley did and evidently still does, then you are not worth your audience’s attention or time.
Recommended and required reading
Robert Ede’s piece on SpAd life for Nuffield Trust is reasonably interesting.