Cowper's Cut: Barclay banks on an ignorant audience

It'd be nice to say that Steve 'The Banker' Barclay, our re-tread Health But Social Care Secretary, seems like an interesting character with something about him.

It would not, however, be true.

The dim following the dumb

The Banker continues the post-Jeremy Hunt trend of profoundly unimpressive Secretaries Of State in this department. First, we had Alan Partridge tribute act Matt Hancock, whose current 'Celebrity' status must surely lead him to the chat show he was born to host: 'Hancock's Half-Hour'.

Alan was replaced by human shrug personification Sajid 'The Saj' Javid. As well as giving the worst 'future of the NHS' speech by a health minister in recorded history, The Saj left a legacy of his gnostic analysis that the NHS was "a Blockbuster service in an age of Netflix".

Barclay Mark One brought us "urgent hackathons"; touring London A&Es in the back of an ambulance on his first full day in post; "over 50" new surgical hubs; and talk of flat-pack new hospitals. So we had fair warning, really.

Then there was the deeply special spectacle of Trusstafarian ultra Dr Therese 'Tiz' Coffey. In years to come, we will look back on Dr Tiz's legacy in the job (telling staff to be positive while worrying about Oxford commas; the ABCD solution; lobbing unprescribed antibiotics around like sweeties). We will laugh nervously, and quickly change the subject.

The Banker misleads

His speech to the NHS Providers' conference yesterday was remarkable, but not in a good way. The initial reception to this speech was interesting. It was generally gratefully received, because it was not directly aggressive towards its audience or the NHS overall.

That gives us an interesting index of where the NHS and its leadership is right now, in confidence terms. The system leadership has reached the stage of Stockholm Syndrome where it is almost pathetically grateful that the Secretary Of State doesn't throw salad at it in rage.

It is telling that salad is coming to define this Conservative Government.

The Banker's specifics

The opening bit of pertinent content was about a dozen paragraphs in, where The Banker told his audience "in these difficult times, I am extremely keen to work with you on identifying all the practical measures that we can put in place to support the NHS and care workforce.

"If I can make the point more explicitly, when people ask what my priorities are for the NHS then supporting the workforce is first amongst those priorities". Doesn't that sound smashing?

So what will this workforce support be?

Mr Barclay does not say.

Indeed, his one subsequent mention of the workforce is to tell staff that their pay demands will not be met.

You say you want a devolution

The Banker makes some promising noises about a "devolved and data-driven approach ... to move away from blame being attached to particular parts of the system for problems that arise but are the consequences of issues that have arisen elsewhere in that complex system".

Yep. Once you have a combination of ten years of austerity; shredding social care; failing completely to improve or expand general practice; ignoring public health and rendering district and community services; you've banked up quite a few big and costly problems. And this is what the post-2010 Conservative Governments have chosen to do.

In the words of health policy guru Lou Reed, "you're gonna reap just what you sow".

Hostages to fortune

The Banker offers a platoon of hostages to fortune, with his statement that "it is far better that variation in the different needs of demographics and local healthcare systems is reflected in devolving decisions to local leaders, who of course are better placed to assess the trade-offs about where risk sits within those decisions, rather than it being determined in a one-size fits all way within a ministerial office.

"So a key direction of travel will to be empower the ICBs much more to harness advances around population level data, with the role of the centre being geared around supporting areas to address those variations in performance – of which, of course, you all play one of the largest parts.

"We will support Trusts in stopping lower priority spend so they can prioritise areas that matter most to patients – like cancer care".

There are problems here. When the NHS is in crisis (which it has been for some years now), the system knows how to grip. It only tried a devolved approach during the initial wave of Covid19, when local organisations were given material freedoms to adapt to survive.

Indeed, Mr Barclay and all of his Conservative MP colleagues specifically voted for the "more Matt Hancock" powers in the 2022 Health And Social Care Act.

Maybe it's a 'taking back control' thing, but the Hancock Paradox is real. Systems do what they've learned to do, and in the NHS's case, that is to grip when in crisis. When all you've got is a hammer, everything looks very much like a nail.

The Lansley reforms took 30% out of NHS management and drove an NHS re-disorganisation "so big you could see it from space". The possibility of a devolved and data-driven NHS would only exist if that had not been done.

We also await with bated breath a definition from Mr Barclay for Trusts' "lower priority spend". Maybe it's stuff like free car parking and food available 24/7 for those, ahem, all-important staff?

A right estate

Mr Barclay told the audience that "I am committed to delivering the government’s commitment to eradicating RAAC from the NHS estate". This is profoundly unambitious.

Thirty buildings at 20 different hospitals run by 18 individual NHS trusts have between one and four RAAC roofs.

Under a Freedom of Information request by the Lib Dems on the target date for removing all RAAC from hospital roofs, NHS England stated that it would not happen until 2035, and could not say how much the removal of all RAAC would cost because “this information is not held by NHS England”.

The cost of backlog maintenance in the NHS recently went over £10 billion.

The Banker also asserts that "if you look at the last 10 hospitals, nine of the last 10 hospitals built in England were over time and over budget".

Ahem.

Ahem, ahem. The last two major NHS hospitals built were both by failed outsourcers Carillion; and before that, the previous big one was Jim Mackey's Northumbria Emergency Hospital.

And this Carillion point makes The Banker's next statement truly astonishing: "it interests me that, given where we were four years ago, as Minister of State in the department I visited the Royal Liverpool Hospital, which I was told four years ago was near completion when on my visit to that hospital - and four years later I am now visiting again today with it only opening last month.

"So there is an urgent need to change how all NHS buildings are constructed in the future".

This is bullshit from the Secretary Of State. He constantly makes a great deal of his time working in the Treasury and as a minister in DHBSC, during which latter role Carillion collapsed into administration. (Indeed, Carillion repeatedly tried to sue the NHS in Liverpool.)

The likelihood that Mr Barclay was unaware of its two enormous NHS contracts in Birmingham and Liverpool, both of which were stalled because of Carillion's delivery failures, is zero.

Indeed, here Mr Barclay is talking about the issue in September 2018.

So not only is Mr Barclay lying by omission to his audience, but (in the parlance of the old standing football terraces) he's pissing down their backs, while telling them it's raining.

Carillion's collapse was nothing to do with the NHS; nor how it was required to procure hospitals using only PFI. The rest of The Banker's analysis about infrastructure should be treated with similar caution.

This kind of second-rate bullshitting and lying by a Cabinet Minister is only possible because so much of the UK's national media is third-rate. It is as depressing as it is instructive that none of them spotted this.

Coda

The Banker even goes on to mention "The Internet Of Things". It's almost like having Simon Burns back, but without the good hair, the Marlboro Reds and the being David Bowie's cousin.