Cowper’s Cut 363: When all you’ve got is financial lying, everything looks like capital-to-revenue transfers
The Labour government highlighted their early (relative) win of getting the extra two million diagnostic tests delivered a few months early with their announcement earlier this week.
Prime Minister’s Office, 10 Downing Street
Since they took office, the RTT waiting lists have indeed fallen by almost 160,000: they still remain hugely long, at 7.5 million waits across 6.2 million individuals.
NHS England provided 2.2 million more appointments for planned care (including chemotherapy, radiotherapy and diagnostic tests) between July and November 2024 than during the same period in 2023. The absence of pay strikes play a role in those numbers, which was very much a Labour choice about how to use the extra money allocated for the NHS.
It makes us think about the financial year ahead.
NHS England
The recent NHSE operating guidance is clear that the extra funding “must cover final pay settlements for 2025/26, increased employer national insurance contributions, faster improvement on the elective waiting list and new treatments mandated by NICE.
“Overall, this means NHS organisations will need to reduce their cost base by at least 1% and achieve 4% improvement in productivity, in order to deal with demand growth. NHS England will transfer a higher proportion of funding than ever before directly to local systems and minimise ringfencing, allowing local leaders maximum flexibility to plan better and more efficient services.”
Mmmmmm. The NHS has never in recorded history achieved 4% productivity improvements, and while the Institute for Fiscal Studies noted and welcomed recent hospital productivity gains, making a 1% cost base reduction and a 4% productivity gain in a single financial year is an heroic ask.
“Unhappy the land that needs heroes”, as Marxist propaganda-maker Bert Brecht imagined Galileo Galilei saying.
Henry Anderson
On top of this, the elective recovery fund has been capped for the coming financial year, and the independent sector is kicking up about new regulations which make it seem that they might have to treat patient numbers above a contractual cap free of charge.
James Illman
The NHS financial mantra looks truer than ever: when all you’ve got is financial lying, everything looks like capital-to-revenue transfers. Keep your eyes peeled.
Velocity Girl
Rumours can be calibrated in three dimensions: volume, velocity and veracity.
The progress of the 10-Year NHS Plan (now likely to be delayed from May 2025 to June 2025, partly due to ill-hidden 10YP leaders’ internal power-dynamic discontent) and the appointment of Dr Penny Dash as NHS England’s chair-nominate have combined to set fresh discourse flowing about the future of The Woman In Black, Amanda Pritchard.
‘Cut’ readers need little reminding that my less-than-confidence about Ms Pritchard’s likely longevity in post is not a recent thing. It’s been interesting to observe the mainstreaming of this view over the past few years.
I write this with no animus whatsoever towards her: she is simply not a leader; and she neither has followers organically, nor has successfully created any. This is untenable for such a high-profile and politically-inflected job.
I’m not persuaded that the current rise in volume and velocity of ‘Amanda’s going’ rumours is matched by their veracity. Even a broken clock is right twice a day (if rarely usefully so): connoisseurs of NHS gossip will also recall the Stakhanovite determination of the ‘Simon’s going’ tendency, and that The Messiah finally announced his departure when those tales were at a remarkably low ebb.
In departing as NHS chief executive as in comedy, timing is everything.
A Pritchard Problem
This doesn’t mean that Ms Pritchard’s unsuitability has not been noticed by the powers that be. Quite the opposite: for all the faux-declarations of total confidence in The Woman In Black, those in important roles have known for many months now that they have A Pritchard Problem.
It seems that the current rumour-vogueing has fallen out of a quite reasonable working-back from the proposition that NHS England will soon have a new chair, and within four months a new ten-year plan that requires a credible leader to start to see it through.
Even though you heard it here first, prognostications about The Woman In Black’s career future have been in Doris Stokes territory for some time now.
But movement isn’t yet imminent. While there is widespread knowledge that the new centre of power has A Pritchard Problem, I understand that they have not yet reached a consensus on what exactly to do about it, or on when.
Lost in the system
Among the 64% of the 1,888 adults polled who experienced a difficulty:
- 32% had to chase up the results of a test, scan or X-ray.
- 32% had not been told how long they would have to wait for their care or treatment.
- 23% were unaware of who to contact while they waited.
- 20% received an invitation to an appointment after the date had passed.
Poorer people, those with long-term health conditions and those from ethnic minority backgrounds are more likely to have a bad experience of their interaction with the NHS. For example, 75% of those with a chronic illness encountered a problem compared with 57% of those in good health.
The Alan nostalgia
Tim Durrant
Well. It may or may not have had to happen: but here we are anyway.
Sporting the most post-divorce haircut imaginable, The People’s Partridge himself, Matt ‘Alan’ Hancock has been invited to share his pearls of ministerial wisdom with a grateful nation by the generally-sensible Institute For Government.
It is quite as bad as you’d imagine. Alan’s finest achievement was, he claims, the Covid19 vaccine: a fine thing, to be sure, but one that was in The Real World led by Dame Kate Bingham and rolled out by NHS England with military support.
An accompanying, embarrassed-seeming IfG commentary suggests that Hancock was responsible for the creation of integrated care systems in the 2022 Health And Care Act, and if they ultimately succeeded, he may be due some credit.
This is ahistorical: the move away from the purchaser-provider split and Lansley reforms and towards integrated care systems was very much the work of Simon Stevens, both in the Five-Year Forward View and his subsequent words and deeds.
Indeed, Stevens was explicitly asked to write most of what become the 2022 legislation: Hancock was responsible for the section which explicitly restored the Health Secretary’s control over NHS England.
A-haa!
Recommended and required reading
In a less-than-stellar week for medical regulation, the Royal College of Physicians was forced to announce that almost 300 people were issued with the wrong 2023 MRCP(UK) Part 2 exam result. Out of 1451 candidates in the MRCP(UK) Part 2 Written Examination on the 6 September 2023 (Diet 2023/3), 283 were given the wrong result - 61 candidates who were told they had failed have passed and 222 candidates who were told they had passed have failed.
As if that were not bad enough, the Boris Johnson Fanzine this week revealed that the GMC had a policy of wiping the public disciplinary records of doctors who identify themselves as transgender.
New Nuffield Trust report looks at what the NHS staff survey tells us about the changing behaviours and motivation of healthcare staff.
Economist piece on how Chinese pharmaceutical companies are now at the forefront of father, cheaper drug discovery.
Financial Times long read reports on the death of the journalist’s brother due to various service failures.
Depressing Sunday Times piece about inter-consultant struggles within Barts Health NHS Trust facial trauma surgery unit.
Decent Health Foundation podcast with Nigel Edwards and Hugh Alderwick on what should be in the NHS 10YP.