Oct 6, 2024 11 min read

Cowper’s Cut 343: ‘And is there money still for tea?’

Nostalgia isn’t what it used to be, as Rupert Brooke’s past-fest poem ‘The Old Vicarage, Grantchester’ proves with its final couplet “Stands the Church clock at ten to three? / And is there honey still for tea?”

We are five months into the 2024-5 financial year, and as Health Service Journal’s Henry Anderson notes, the English NHS is set to breach its ‘permitted’ deficit.

Henry’s piece notes that “England’s 42 integrated care systems recorded a collective deficit of £2 billion in the four months to August, compared to a planned £2.2 billion by the end of the 2024-25 financial year.

“Finance reports show around a quarter have already neared or surpassed their full-year deficit in four months and will have to bring spending down significantly to meet their financial plans.”

NHS overspending just isn’t what it used to be. 2024 > 2006.

And is there money still for tea?

So, is more money coming?

The Mirror’s Ashley Cowburn has been briefed that if any further revenue is found at the Budget, the NHS will be at the head of the queue: “The Chancellor will prioritise putting any spare cash on cutting record waiting lists of over 7 million and repairing the broken health service.

“A Treasury insider told The Mirror, “we know that cutting NHS waiting lists is a priority for people”.”

NHS England’s lack of credibility

This first part of the write-up of the recent HSJ provider chief executives roundtable gave us explicit sight of the relationship between the national leadership of NHS England and NHS provider organisations. And it is not good: principally, over the issue of money and NHS England’s insistence on the system’s active collusion in financial lying.

Somerset Foundation Trust chief executive Peter Lewis said it was “totally clear” the NHS was not handling financial planning discussions in the right way, suggesting that there was “no point” in having “honest conversations” with NHS England when putting together annual financial plans: “there’s an answer that’s required [by NHSE], and if [they] don’t get that answer, you just get told to go back and try again. You can’t really have a conversation about what are the [underlying] issues and what are the solutions you need to put in place to address those issues.”

Hampshire Hospitals Foundation Trust chief executive Alex Whitfield said that NHSE’s advice when putting together the trust’s financial plans was to make “more heroic assumptions”. She recalled NHSE officials suggesting: “if you just put in a bigger and bigger number, that will generate a plan that looks nicer.”

I wrote about this five years ago, back when this column used to run in HSJ: “The consequences to a culture of financial lying and incentivising the wrong things are not only when these accountancy fiddles reach a wider audience. Which they will, over time.

“The consequences are bad decisions in the here and now. It is starting to feel as if the NHS might need a financial truth and reconciliation commission, as well as a chief anthropologist.”

NHSE’s financial surrealism has been a theme of these columns for some time now, and clearly it will remain one for some time ahead. The real issue here is just how impotent and broken NHSE obviously is.

Unfortunately, the English NHS runs on fear of the centre, and has done for some decades now.

Fortunately, as this HSJ event shows us, chief executives have realised that NHSE’s leadership is too confused, option-free and weak to sack them, and that nobody else much wants their jobs.

Weather alert: expect further outbreaks of candour as the autumn rolls on and high pressure rolls in.

Hurrah: a ‘Red Tape Challenge’!

“Amanda Pritchard and I will launch a Red Tape Challenge to bulldoze bureaucracy so GPs are freed up to deliver more appointments. The challenge will be led by Claire Fuller and Stella Vig, primary and secondary care leaders who have their bulldozers at the ready. Tell them what’s working well, but more importantly what needs to change. We will listen, act, and solve this problem together.

“Amanda and I will receive the conclusion of this work in the New Year. And NHS England will hold ICBs and trusts to account if they fail to act.”

Secretary Of State Wes Streeting, speech to RCGP Annual Conference

‘Red tape is fun!’ was Bernard Woolley’s gorgeous bid in the BBC TV classic ‘Yes Minister’ episode ‘The Writing On The Wall’.

It would seem that SOS Streeting agrees, announcing one in his speech to the Royal College of GPs this week.

And it’s bound to be as big a hit as, say, the 2011 Red Tape Challenge.

Or the 2013 version.

Andrew Lansley was famously anti-Red Tape, telling the NHS Confederation’s 2011 Conference that “I have been a critic of excess bureaucracy, of red tape, of an over-administered National Health Service”. (Have a re-read of that speech: it is bathos in excelsis.)

Then there was the 2015 ‘Cutting Red Tape’ review of adult social care: clearly another triumph.

In July 2020, no less a figure than The People’s Partridge himself, Matt ‘Alan’ Hancock boldly announced that he was “urging people across the NHS and social care to speak up about what red tape you can do without to allow you to better deliver the high quality care you are renowned for.”

In 2022, Steve ‘The Banker’ Barclay brought us the Hewitt Review of ICSs to explore “how best to cut through red tape and boost efficiency, financial accountability and autonomy”. And that was another triumph.

This latest red tape challenge will undoubtedly match its many predecessors.

Meanwhile, at the Conservative And Unionist Party Conference …

5. almost no one is asking why public services are bad - there is no self-analysis or culpability about NHS, waiting times or access to GP, even when pollsters tell them this is a key factor in defeat - recognising & addressing this failure is just not part of the debate
— Theo Bertram (@theobertram) October 1, 2024

Apparently, the Conservative And Unionist Party held their annual conference this week. The programme had absolutely no plenary sessions on health and care: merely some fringe events sponsored by various lobby groups and think-tanks, to which Bob The Whippet’s Emotional Support Human and shadow of her former self Victoria Atkins was reportedly ‘invited’.

🎥 How to save the NHS, at Conservative Party Conference

w/ @rcolvile @victoriaatkins @Thea_Stein @QuigleyAnna @greenmiranda #CPC24 https://t.co/rgp6GexJw2
— Centre for Policy Studies (@CPSThinkTank) September 30, 2024

One of these sessions, funded by the Centre for Policy Studies, was titled ‘How To Save The NHS’: coming straight after 14 years of Conservative And Unionist Party government, it’s hard to be sure whether this is anhydrously dry irony, or the peak nationalisation of getting publicly owned by your own side.

It is likely to be some time before the Conservative And Unionist Party need trouble our health policy and political attention again, outside of being blame-recipients.

PAs/AAs row rumbles on, as RCP trustees chair resigns

Events tell us that the Academy of Medical Royal Colleges has learned nothing and forgotten nothing from its ill-judged attempted interventions in the recent pay disputes, in which it had absolutely zero standing.

It has tried the same move again over the catastrophically mis-handled attempt to ram through the new medical associate roles, with the chair of council Dr Jeanette Dixon writing this bathos-drenched letter to SOS Streeting and NHS England pro tem boss Pritchard.

Apparently, naughty, naughty people are saying bad things! “Much of this adverse commentary is driven by information circulating across social media platforms. Increasingly these claims, which often focus on patient safety or restricting access to training opportunities for resident doctors are becoming part of a wider accepted narrative.

“However, the degree to which these statements and resulting counterstatements are based on sound evidence is unclear. As a result, this conversation is almost devoid of factual information. As doctors, we must always be evidence-led, and we believe that it is essential that we establish and assert the evidence base in this case.”

Bit late, eh? And demonstrably not the purpose of the AOMRC.

One must have a heart of stone not to laugh at this unadulterated pomposity: speaking of which, the chair of the trustees of the Royal College of Physicians Professor David Croisdale-Appleby this week announced his departure with immediate effect. The RCP’s official announcement is a masterpiece of the unsaid.

‘AI will save the universe!’ Bollockswatch

The Financial Times reports that DeepMind and Covid19 vaccineers BioNTech “are building AI lab assistants to help researchers plan scientific experiments and better predict their outcomes as companies race to find specialised applications for energy and data-intensive artificial intelligence models.

“Sir Demis Hassabis, chief of Google’s AI arm, is leading the company’s efforts to develop a specialised AI model to act as a research assistant, helping scientists to collaborate across disciplines and make unexpected connections more easily. At a recent Nobel Foundation event, he said biology was “seeing a revolution” as a result of AI software. “We’re working on a science large language model that could be like a research assistant and maybe help you predict … the outcome of an experiment”.

Like a research assistant who won’t nick your lunch or request annual leave. Mmmmmm. Maybe.

Two contrasting views of our new tech overlords were aired at The Times Tech Summit this week.

Machine learning expert Professor Neil Lawrence warned the credulous and unwary that the AI hype is a crock. He’s my kind of machine learning expert.

Professor Lawrence told the event, “when you hear Feryal Clark (Labour’s new minister for AI and digital government) saying public services have completely failed, that’s simply not true. Most things work, actually. There’s a lot of stuff we’d like to fix [but] once you get this notion that, ‘that’s all failed, let’s replace it with AI, and some AI general intelligence can fix it’, that’s extremely dangerous.”

Lawrence said the idea that AI could be imposed on public services to “fix everything” represented an “absurd and reductionist understanding of the complexities of human intelligence and human society”.

One of these two people actually understands what AI is and does: the other is Labour’s minister for AI and digital government.

The hypebeast role was ably filled by Google DeepMind’s Sir Demis Hassabis, who reportedly predicted that artificial intelligence with general human cognitive abilities will be reached within ten years, and that the technology holds the potential to “cure all diseases.

“We are in shooting distance of curing all diseases with AI, helping with climate [crisis], new energy sources, as well as improving productivity, enriching our daily lives, making mundane admin things be dealt with automatically. Those are all amazing, and it’s all coming very soon.”

So that’s nice. [coughs] Self-driving cars. [/coughs]