Editorial Thursday 12 January 2017: Mayan civilisation and punishment leakings

Six months since her arrival in 10 Downing Street after the other Conservative leadership candidates disappeared in puffs of stupidity and self-importance, we can tell the founding philosophy of Team Theresa May.

'If at first you don't succeed, make precisely the same mistake again - but even harder'.

The punishment leakings will continue until morale improves
I wrote last October about Team TM's counter-productive and politically inept punishment leaking of the events of a meeting with Simon Stevens and Jim Mackey.

Mrs May's team didn't get much joy out of that effort. So like any good learning-averse SpAds, her people did the same again in Wednesday's Times - only more so.

This new briefing accused Simon Stevens of being "insufficiently enthusiastic and responsive", which sounds more like a review of a blind date. Perhaps Team TM should work out whether they're trying to off Simon Stevens, or get off with him. I mean, the beard's very on trend ...

This was a brilliant way to get the nation's political correspondents to focus fully on Simon Stevens' evidence to the Commons Public Accounts Committee session on NHS financial stability. The smarter ones laid on popcorn.

This all takes place in context, little of which is good for the Government. NHS performance and pressures have scarcely been off the front pages since Christmas. The latest performance data from NHS England, ably summarised here by the House Of Commons library, leave fans of facts in no doubt that not only has the shit now hit the fan, it has been turned on, and is starting to speed up with predictable, predicted consequences.

A&E attendances are 5.4% higher in 2016 than in 2015, with emergency admissions up 4.6%.

The waiting list for routine treatment grew 13% to 3.72 million between November 2015 and November 2016. During that time, delayed transfers of care were 26% higher, with 47% more delays due to waiting for homecare or nursing care.

131 of 139 major A&Es missed target over the period with a  54% increase in trolley waits.

The unfortunate remarks by British Red Cross CE Mike Adamson calling the matter "a humanitarian crisis" bought column inches, but gave the Government the reasonable rejoinder that a serious NHS access crisis (which let's be in no doubt, this is) cannot sensibly be compared to Ebola or Syria.

Looking at what rhetorical inflation did to politics in 2016, some care in NHS political rhetorical inflation would be welcome.

Stretching it
So, in the wake of Mrs May's televised assertion on Sophy Ridge On Sunday that "we gave them more funding than they required", was Simon Stevens going to be loquacious, or Bartleby The Scrivener-like 'I would prefer not to' in his answers to the PAC?

This was a front-foot attacking performance: Stevens told the committee "like probably every part of the public service we got less than we asked for in that process. So I think it would be stretching it to say the NHS has got more than it asked for ... There are clearly very substantial pressures, and I don’t think it helps anybody to try and pretend that there aren’t".

When the DH's Chris Wormold asserteed that UK health spending was in line with the OECD average. Stevens countered that the comparison was misleading because OECD data includes countries like Mexico; that the UK spent less than on health than comparable advanced nations; and that it spent 30% less on health per head than Germany.

What we learned
Theresa May's Number 10 operation is simply crap at media manipulation. They turned Simon Stevens' Commons PAC gig into a box office open goal.

Surprise, surprise: Simon Stevens slotted it, time and again. The £10 billion lie was once again deconstructed. Team May also don't have a health policy (as Times health correspondent Chris Smyth noted); they know they need one, and are resentful they need Simon Stevens to provide it.

Conventional wisdom would have it that you don't go to war with the Prime Minister. But conventional wisdom doesn't have the NHS brand in its corner.

Most of the public are not political or policy geeks. They are certainly not members of political parties. They think about politics infrequently, and may or may not vote. The NHS is more present in their and their families' lives than political parties are: it is more real to them. They do see the media, though, and are by now well aware that the NHS is not doing well under the current administration. And if they see headlines in Wales and Scotland, they note that it is not only the English NHS having serious problems.

The national media have, finally, begun to rumble the fact that the £10 billion figure is nonsense. Today's coverage shows they are broadly well-disposed towards Simon Stevens. There have been no editorials calling for him to go, in marked contrast to his predecessor David Nicholson.

NHS chief executives have been politically controversial in the past, as Duncan Nichol proved.

Here is a prediction: in the sack race, Simon Stevens will, if he wants to, remain NHS England chief executive after Theresa May has been defenestrated.

However. Nobody has a plan that will fix NHS performance and pressures any time soon. There is no untapped pool of resting doctors and nurses domestically, and Brexit has not made us a more attractive place for those globally in-demand staff to come.

There are also more factors in this than funding alone. There are non-existent IT systems to support bed management. There is poor records access. There is too little attention to nosokinetics - the science of patient flow. There are clear problems in delayed transfers of care due to local government cuts and social care market failures and cost pressures. There is an ageing, ailing population, as Simon Stevens noted.

There is also crap culture. There are NHS organisations which think bullying is effective: nationally and locally. There are employers who don't get the importance of well-treated staff, physically, mentally and emotionally. In the face of ongoing high workload pressure, that is depressing.

The politics of this are fascinating, but the front line is not being manned by politicians, system leaders or even (hard as it may be to believe) mouthy independent commentators.

It is down to the staff. Thank you, people.

Mayan society
The parallels between Maya civilisation and health policy in the Mayan era are striking.

Classic period rule was centred on the concept of the "divine king", who acted as a mediator between mortals and the supernatural realm.

The Maya employed mathematics that included one of the earliest instances of the explicit zero in the world.

As a part of their religion, the Maya practised human sacrifice.

If you're going to go down the last route, you need to make sure you're not the sacrifice.