Jan 26, 2025 7 min read

Cowper’s Cut 359: A farewell to fiction

In 2019, I wrote in the BMJ of the Boris Johnson government’s health pledges, “the Tory manifesto has an air of the surreal, and it’s hard to know where to even start with such a blatant cocktail of the misleading and the untrue: it promises ‘40 new hospitals’ … just six hospitals have actually been promised money for significant redevelopment by 2025, with another 38 pledged ‘seed funding’ sums of money to plan for redevelopment.

“Yet Boris Johnson has repeated his claim of “40 new hospitals”, though the party’s costings document gets the numbers correct, referring only to ‘20 hospital upgrades’, rather than new hospitals”.

Ahem.

‘Cut’ readers have grown wearily familiar with my re-naming of the subsequent set-up as the New (If Fictional) Hospitals Programme.

This week saw an official acknowledgement of reality from the Labour government, with their announcement of the reprofiling of the proposed schemes, pushing several back into the Parliament after the Parliament after next.

18 of the 40 schemes which were allegedly due to open in 2030 on the last Conservative administration’s fictional timetable and budget will now not even begin construction until then: some look set to face delays until 2039 before they even begin construction.

What the F

It gives me zero pleasure for my critique of the N(IF)HP to have been vindicated so absolutely. As I wrote last week, the major mismatch between what the Treasury are making available for English NHS capital spending and what is needed is going to have to drive some new approaches.

A new National Audit Office report this week warned of the disruption to public services by UK government buildings being “left to crumble”.

And new analysis by the National Institute of Economic and Social Research shared with The Times observed that “successive UK governments have made payments to private companies that built and managed public assets — such as schools and hospitals — which are, on average, more than three times the cost of construction.

“ … based on an examination of more than 1,000 financial accounts of companies that constructed and maintained infrastructure … they distributed £300 million in dividends to investors from £1 billion in profits between 2005 and 2022.”

This isn’t surprising (the economics of PFI are highly propco/opco-friendly), but it is striking.

So, what is to be done?

I was thoroughly impressed (although not surprised) by the savvy political approach taken by Barking Havering and Redbridge chief executive Matthew Trainer’s move to have posters in hospital corridors apologising for corridor care, delays and overcrowding and enabling patients via a QR flashcode for smartphones to lobby their MP directly to support redevelopment, as reported by Health Service Journal.

This initiative was also picked up by Eleanor Hayward in The Times.

While this facilitated lobbying won’t produce immediate results, it beats the hell out of learned helplessness and inaction. I mean, I suppose that if this seems far too daring, local leaders could always wait for NHS England to have a really, really strong word (or at least some loud tutting and a cross look) with ministers behind closed doors: that’s always proven hugely effective so far …

Streeting to ensure choices get made over national targets

The verdict is in on Health But Social Care Secretary Wes Streeting: he’ll never get a job as a senior manager at NHS England.

I know: he’ll be inconsolable. But you can’t go around ensuring that actual decisions get made about trade-offs and expect to be in The Woman In Black’s gang.

Streeting’s team told The Times’ Chris Smyth that they “will abolish a host of goals in areas such as women’s health and learning disabilities, as sources say the NHS must stop giving in to interest group lobbyists.

“About half the detailed instructions previously given to NHS England are to be dropped as Streeting promises to stop “micromanaging” health chiefs. But they will be warned that greater freedom must show results … Planning guidance for 2025-26 to be set out on Tuesday will reduce by half the 32 goals given to the NHS for the current financial year”.

Is this the beginning of the end of NHSE’s Pritchard-era ‘Everything Everywhere All At Once’ tendency? This first step towards prioritisation might be the beginning of the mend: we will have to wait and see how they respond to the tidal wave of lobbying and shroud-waving that is sure to be heading their way.

NHS England to the rescue with leaked national A&E plan!

Whoops! Everybody’s favourite former Commissioning Board accidentally leaked a working draft of their national plan to tackle the A&E crisis to HSJ, in a manner that was obviously wholly unintended to try to distract attention from the ongoing winter crisis.

Matt Discombe reports that “the … 10 action points for trusts and systems ... include aims to reduce 111 calls put through to 999 or A&E, and “avoidable” ambulance conveyances and handover delays; implement rapid triage at the “front door” of A&Es; improve patient flow and access to mental health services; and deliver more care closer to home”.

Thank goodness for NHS England! I hope that subsequent drafts of this plan will also include the phrases ‘God is love’ and ‘please adjust your dress before leaving’: it would be a shame not to have a full house of cliches and platitudinous statements of the obvious.

Indeed, this draft document reveals NHSE to have an adorable faith in its capacity and capability to drive A&E improvement, with the vow that “NHSE “must be stronger in holding acute providers to account for reducing ambulance handover delays”, including assessing average time for handovers, rather than the current focus on the longest.

“ … NHSE should separately “performance-manage” A&Es on the length of waits for patients who attend with less serious conditions and therefore are not admitted.

“As part of a “refreshed improvement offer,” an NHSE UEC improvement team will identify around 25 per cent of A&E sites which are “most in need” and work with them on “a clinical commitment to change whilst deploying multi-disciplinary improvement support” for a time-limited period”.”

Without wanting to be avoidably discourteous to Team NHSE, their track record of doing any of these things to demonstrably positive effect is non-existent.

Why have these obvious things not been priorities in the past? Why will it be any different now?

What the F

Streeting to ensure choices get made over national targets

NHS England to the rescue with leaked national A&E plan!

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