Sep 22, 2024 11 min read

Cowper’s Cut 341: Wes Streeting, Swiftie and Motörhead-head

Resident doctors settle for offer over pay

It may not be everything they requested, but it’s a big step in that direction. So far, so good for the artists formerly known as junior doctors’ democratic decision to rebrand themselves as ‘resident doctors’.

Oh, there was another thing too, wasn’t there?

Junior doctors in England, thank you for voting in the referendum and making your voices heard. The votes are tallied and 65.97% of you voted to ACCEPT the Government’s offer.

Your committee met this evening to ratify the result. We’ll be in touch soon about what happens next. pic.twitter.com/IwRD36yjBD
— Resident Doctors (@BMAResidents) September 16, 2024

Ah yes, it was something about pay.

In an outbreak of mass sanity, BMA resident (junior, as were) doctors this week voted by a 66% majority (on a 69% turnout) to accept the Government’s pay deal which their leaders negotiated, recommended and then promptly rowed back on.

Please, sir, I want some more

Like a B-movie version of ‘The Terminator’, they‘ll be back, probably in a year’s time. This is all very far from over.

We saw more low-quality hostilities over this pay deal between Secretary Of State For Health But Social Care Wes Streeting and his former oppo, Bob The Whippet’s Emotional Support Human Victoria Atkins.

Do you support or oppose the deal?

Your statement is clear as mud.https://t.co/qGOt1VMMEk
— Wes Streeting MP (@wesstreeting) September 18, 2024

So far, so pantomime. (‘The resident doctors are BEHIND YOU!’)

On to the practicalities. These increases in pay, and in particular the lump sum of back pay from April 2023, are expected to be issued to RDs in November 2024.

This fresh financial burden is a massive problem for an English NHS where deficits are breaking out like bouts of respiratory illness, at a time when vaccination rates among children are down and winter preparations aren’t really making much traction.

The Real Pink Paper also gave us the Guys and St Thomas’ hiring freeze story, which is a further barometer of financial failure - and this for the hospital literally across the bridge from the Houses of Parliament. That really is a sign of the times.

Streeting: Motörhead > Status Quo

Mr Streeting’s recent NHSE / DHSC joint briefing was the subject of a news report in Health Service Journal. He told staff across the organisations that he will reject any proposals “that suggest sticking with the status quo, or bids for more money without reform”.

Not ‘Whatever You Want’, then. He’s more of a Motörhead fan, it seems: “you win some, you lose some: it’s all the same to me … that’s the way I like it: I don’t want to live forever”.

Of the Darzi Review, Mr Streeting said, “I want this report taken as gospel. Our response must be: to take it on the chin, pull up our sleeves, and begin the hard work of reform.”

SOS Streeting promised his audience that what lies ahead for the NHS in England will be “major surgery, not sticking plasters”, informing them that he wanted “bold, radical reform proposals”.

Got the BRRPs

But where, oh where will these BRRPs be found, if the Government is truly going to be living in Financial Times?

The Real Pink Paper this week reported the advent of a ministerial (if over £600,000 (or permanent secretarial (if over £100,000) sign-off for all new Whitehall management consultancy contracts.

Is this The Future? Yes, Minister!

This does make me wonder how Alan Milburn’s involvement with DHBSC / NHSE will be remunerated. Bcecause if he does the work via AM Strategy, then it will surely come within scope of ministerial sign-off.

IPPR Commission report and launch

This week also saw the arrival of Lord Darzi’s second report within a fortnight: the final report of the Institute for Public Policy Research’s cross-party Commission On Health And Prosperity.

The report is not much that you wouldn’t expect: it’s thorough, and broadly unsurprising. It is, of course, making its arguments very much on Treasury turf: the references to prosperity and economic value have been the lingua franca of health policy for some years now. I first noticed the dominance of this trend at the Nuffield Trust Summit in 2023, and it is now ubiquitous.

Wes Streeting’s speech had a few interesting moments. One point (which was excised as political content in the DHBSC transcript) was his point about how the right (“The Mail”) is going to have to accept that prevention will involve restrictions on things like sugar, alcohol and tobacco, and the left (“The Guardian”) will have to accept real NHS reform and change: “Unless we do public health reform, the Right will have to accept higher costs for healthcare paid for by higher taxes. I don’t think that’s the price working people can afford to pay.

“The Left have to accept health service reform or there will be no health service, at least not as we currently recognise it.”

Streeting told attendees, “the promise of the NHS to be there for us when we need it has been broken for almost a decade. One hundred thousand infants aged between zero and two have been left waiting more than six hours to be seen in A&E last year. Cancer is more likely to be a death sentence for NHS patients than patients in other countries.

“Fifty years of progress on cardiovascular disease is going into reverse, and patients have never been more dissatisfied with the service they receive. As the Prime Minister set out in his speech, continuing the status quo isn’t an option, sticking plasters won’t cut it.

There was some utter straw man rhetorical nonsense in there too: “reform has always had opponents, often vocal and powerful opponents. But believe me when I say the Prime Minister and I will face down that position because it’s in the interest of patients, the health service and taxpayers in this country. It really is reform or die, and we choose reform.”

Reform or die, or just muddle along still being crap

Bleurgh. “It is reform or die, and we choose reform!” Imagine saying that out loud, in The Real World.

It’s not that binary. There is definitely a ‘muddling along still being crap and pissing everybody off’ option, but I suppose that sounds slightly less headline-y and snappy.

We got some other wonderfully inessential stuff, such as the pledge of “an AI-enabled scanner in every hospital”. Piss off and read your Jess Morley, eh?

There was even something potentially important: Streeting said, “I am determined to rid the DHSC and the NHS of any residual sniffiness about dealing with the private sector … (and to) make the NHS the best commercial partner in the world.”

Mmmmmmm. Well.

If he is serious about this, then he is going to need to hire procurement and service experts who are demonstrably very good at telling false claims from real ones.

That won’t be easy or cheap. It will be about finding the equivalents of Vaccines Taskforce lead Dame Kate Bingham in the fields of innovative medicines, health tech and digital.

These individuals won’t come cheap; nor will they necessarily be easy people for NHSE or DHBSC timeservers to work with. Abrasiveness will be a core part of their skill-set. I genuinely have no idea if a wildly Streeting-centric NHSE/DHSBC will be at all able to cope with such people. The levels of lingual septum proctology being applied to Mr Streeting’s fundament by the director-level people in both organisations is already quite remarkable, and it will get far worse as the mundane apolcalypse of finance and performance deepens. Keep your friends close and the man who can end your career closer, in other words.

Oh, and in the Q&A, Streeting displayed his political nous when asked about FreebieGate, cracking a reasonable distraction gag about “being outed as a Swiftie” over his acceptance of free tickets to see health policy guru Taylor Swift in concert. He can at least think Swiftly on his feet.

Covid19 Public Inquiry update

Former chief nurse Ruth May tells the covid inquiry that the coalition government's decision to scrap bursaries for student nurses was "catastrophic".

Ms May says this effectively cost 5k nurses going into covid
— Henry Anderson (@HMAnderson39) September 17, 2024

It’s an intriguing day in prospect at the Covid19 Public Inquiry this Thursday, as the Inquiry will hear from Professor Kevin Fong (former National Clinical Adviser in Emergency Preparedness Resilience and Response) and Professor Sir Chris Whitty (Chief Medical Officer for England).

Policy Exchange report calls for abolition of NHS England

‘Just About Managing’, the latest report from Policy Exchange, takes as its subtitle ‘The Role Of Effective Management And Leadership In Improving NHS Performance And Productivity’.

The report carries endorsements from three health-literate Conservative MPs: ex-SOS Jeremy Hunt, ex-minister Neil O’Brien and NHS surgeon Dr Neil Shastri-Hurst, but it also enjoys a balanced list of interviewees and advisers. It’s a serious piece of work.

It states that “a greater focus on management capability is needed, as is a deeper understanding of the permissions and incentives which enable or inhibit improved performance and productivity.

“We also need to re-appraise where managers are positioned within the healthcare system. The central bureaucracy today is significant, with more than 19,000 people employed between NHS England (NHSE) and DHSC.

“ … the recently-published Independent Review of NHS Performance by Lord Darzi finds that “regulatory type organisations now employ some 7,000 staff, or 35 per provider trust, having doubled in size over the past 20 years”.10 The “right balance of management resources in different parts of the structure” is needed, he concludes.”

An FOI investigation to inform the report found that “81.1% of NHS hospital trusts and Integrated Care Boards (ICBs) surveyed for this report had not dismissed a single manager in the past twelve months, either for gross misconduct or poor
performance. This included several NHS organisations in the ‘Recovery Support Programme’ (formerly known as ‘special measures’) for poor performance, and some of the hospitals which currently have some of the lowest patient satisfaction ratings and worst outcomes on the NHS Staff Survey”.

Its two most striking recommendations are that “the functions of NHS England (NHSE) should be (re)merged with the DHSC and an NHS Management Board (re)established within the DHSC in its place. The headcount and functions of
the seven NHS Regions meanwhile should be reviewed and roles increasingly delegated either to Integrated Care Boards (ICBs) – or back to DHSC accordingly”.

Mmmmmm. I’ve been a critic of NHS England under its current inept leadership. But although it needs to be greatly reduced in size and scope, I think that on balance there remain some good reasons to retain an independent body. Apart from anything else, it would be interesting to see whether a smaller, much better-focused NHSE under some proper leadership could turn around both English national system leadership and NHSE’s own battered reputation.

Nor is it absolutely clear that, despite its recent ‘wins’ in staffing terms, DHBSC is particularly likely to run the English NHS more effectively. It’s just replacing one powerfully-centralised bureaucracy with another.

The report is on stronger ground when it states that “there are too few incentives for managers which encourage innovation, proportionate and calculated risk-taking and ultimately, a focus on improvement of the things which matter
most to the patient and their families … we therefore recommend that greater weight is applied to patient perspectives in both individual and organisational performance appraisal”.

That’s an idea with genuine potential, as is the suggestions that “a new framework of incentives (and freedoms), including a “Prevention Premium”, tethered to quality improvement for providers should be developed ... Incentives should focus on outcomes, rather than activity alone. They must be focused on health-benefits (i.e. specific care outcomes) but should also give weighting to non-health benefits”.

About that New (If Fictional) Hospitals Programme …

"Gentlemen, welcome to the New Hospitals Programme. The first rule of the New Hospitals Programme is: you do not talk about the New Hospitals" pic.twitter.com/1uBCsFgJxX
— Sebastian Rees (@SebRees1) September 18, 2024

God, I love NHS England.

No, really. Just when I was thinking that the New (If Fictional) Hospitals Programme was firmly lodged in the Long Treasury Grass, they go announcing recruitment to the New (If Fictional) Hospitals Programme. These jobs are advertised online here and here (the LinkedIn promotional advertisement was promptly taken down).