“Of course, the NHS requires more investment … in light of the pandemic, which of course no one anticipated, I guess it’s fair to say that we need to revisit those plans and see how we can add to this plan … we will certainly be looking over the so-called spending review period to see how we can strengthen it even further.”
Health Secretary Sajid Javid to Sky News
With a certain grim inevitability, the latest English NHS waiting times news was bad. Waits for access to care are once again, the worst – longest – on record. Over 5.4 million people strong, and as always, Rob Findlay’s analysis for HSJ is a must-read. It points out that we are not yet seeing all of the pent-up demand returning. (Some of it will not, of course, because it sits in the section of the population which has died of and with Covid19.)
I wrote in last week’s ‘Cut’ about the slow march of the NHS backlog into the centre of political perception. The pandemic both hid and exacerbated this: it will be a defining feature of our politics for years to come.
Pressure on the system remains huge, as you don't need me to tell you. Shaun Lintern of The Independent notes that this week, “soldiers will be deployed to several of England's ambulance services after a military aid request to @DefenceHQ by @DHSCgovuk - I say again for the NHS to be here in August is hugely worrying”. As usual, Shaun is Not Wrong. This FT piece on recovering cancer services is likewise a sobering read.
And in how good a shape are our politics? Not great, if you look at the stories to emerge this week particularly this from, the FT, confirming last week’s tale of Boris Johnson threatening to ‘demote’ Rishi Sunak to Health Secretary.
Way to go about making the NHS feel like a priority, Prime Minister – to present being moved to the brief as a punishment-demotion. That’s been noted, I think it’s fair to say.
The FT story quotes an “influential member of the Government” (who probably occupies the same pair of shoes as chatty chap Michael Gove) as saying “Rishi is making it clear that he hates the silly spending. He is against lockdowns and prioritises economic growth. He represents a set of ideas. Other than Brexit, Boris does not”.
The Gove Who Must Not Be Named adds that that support in the Tory parliamentary party is split “50:50” between Chancellor Rishi ‘The Brand’ Sunak and PM Boris ‘Boris’ Johnson.
Dialogue of the fiscally deaf
The dialogue of the fiscally deaf that will soundtrack our run-up to the Autumn’s Comprehensive Spending Review has yet to throw up much essential reading.
The quote at the top from power-poser and (Rishi willing) Health Secretary Sajid Javid gives us some triangulation, but this week, HSJ reported speculation that our dear chums the Treasury Munchkins are bidding with a 1.5% efficiency requirement for the rest of this financial year in advance of any new settlement.
This is, as Nuffield Trust’s Sally Gainsbury neatly points out, silly. The structural forces that created the NHS underlying deficit have not disappeared. If what’s guiding the Treasury Munchkins is Steve Barclay’s ‘lessons’ from his short stint as a junior health minister, then this CSR is going to be even less edifying than usual.
And the Opposition?
What about the Opposition, then?
It’s a good question. Sir Keir Starmer inherited the Corbyn legacy of a genuine smoking ruin of a political party, and then the pandemic hit. That is a lot. Yet even aiming off for all this, it’s very hard for even keen politics-watchers to have a clue what Starmer is about. He needs to fix this in the next few months.
With this in mind, I had a few thoughts for what Labour need to do. In no particular order:
Learn to attack. The Labour front bench is currently profoundly herbivorous in its attacks on a Government making huge enforced error after huge unforced error. It needs to become carnivorous. It needs to get to like the taste of blood. The ‘Opposition’ bit of being HM’s Loyal Opposition feels like it’s beneath too many of the current shadow Cabinet. In particular, stop wasting the considerable oppositional talent of Emily Thornberry, who consistently knocked Boris Johnson for six when shadowing him at the Foreign Office. Thornberry can deliver the teachable skill of opposition to a shadow Cabinet that is very poor indeed at it. Also, get Yvette Cooper back. This shadow Cabinet is, by and large, deeply average.
Have a story on public spending. The country has seen massive Government spending to address the pandemic. Apart from a select group of Tufton Street Tory think-tank rentamouths, the public has been remarkably OK with this. The lessons of austerity having so comprehensively come home to roost, there may now be political space for an argument to be advanced that public spending is a good and needful thing. Labour need to lead this argument, providing some notice of where they will raise taxes to fund this, and by how much.
Launch a ‘Brown Review’ on NHS funding. The Wanless stuff on NHS funding needs updating: get ex-PM Gordon Brown to do this. He carries clout as an economist, and has not ruined himself in public opinion since leaving office. The outcome of this will drive a single, unified narrative on the NHS.
Have as strong an answer to how Labour would fix NHS waiting lists as they do an attack on their length. If I were advising Labour, I would be looking at how much spare capacity could be bought in the health systems for France, Germany, Belgium, the Netherlands and even the Nordics. Yes, obvious complications with follow-ups, OP work etc, but simply put, we cannot put the extra workforce in place here fast enough to make a difference in a politically relevant timescale. We will of course also need to increase capacity. Know by how much, and by when. Promise an annual audit of progress on reducing waiting times. Have answers not only on workforce, but on backlog/capital spending/maintenance.
Have prepared defences against obviously-coming Government lies on health issues. These include (but are not limited to) ‘Covid19 caused the NHS backlog’; ‘Brexit let us do Covid19 vaccines procurement our way’; and ‘we’re building 40/48 new hospitals’. The rebuttals need to be able to be articulated in two clear sentences that every Labour MP knows by heart, and backed with linked evidence on the Labour website. Every response needs to start with “No, that’s a lie: in reality …” This is crisp, concise, barnacles-off-the-boat communications. It isn't rocket science, but labour are currently very bad at this.
Shut up about fictional NHS privatistion, permanently. I mean, obviously. Really, REALLY obviously. Go after the 2010-19 Conservative and for a time, Lib Dem coalition NHS defunding, by all means. Ministers actually know that this ‘NHS privatisation’ t’ut is complete and utter bollocks, but stick with it because it makes some of their activists feel warm and fuzzy. Labour will stand a chance of forming another government only when it learns to tell such activists to piss right off. If Labour want to do something meaningful on private provision, they could cost the replacement of lousy privately-provided higher-tier mental healthcare, particularly for children and people with eating disorders, with a public option.
Right, well, that’s the Labour Party fixed. (As if …)
What else has been happening?
Ahem. Health Policy Insight subscribers already knew about the 100% inevitability of this since 28 July. You’re either in front of ‘Cowper’s Cut’, or you're behind. Just saying (repeatedly, I should imagine).
And so farewell to the noble Baroness. If you tell your board you only want to be considered as a CE, then your bridges are self-evidently already burned. It’s an interesting approach, to be sure.
Getting the Bill
The Health And Care Bill has moved on into its committee session, and all of the MPs sitting on the Bill committee have now been announced. Health Minister Ed Argar, formerly of Serco, is going to be playing the Simon Burns role.
MPs for Charnwood aren’t what they once were, and I do not think we will have the same level of political greatnessas that with which The Burns Unit graced the last Health Bill committee, but you never know.
As previously stated, the first two sittings will be on 7 and 9 September.
Life after life science
The life sciences are meant to form a big part of the UK economic recovery post-Covid. And what could say ‘Building Back Better Life Sciences Vision’ more clearly than getting the Medicines and Healthcare Regulatory Authority to cut up to 25% of its workforce, as the FT reports?
Meanwhile, the Sunday Times notes that Glaxo and AstraZeneca look set to be spending more time and money with their lawyers as they fight over licence payments regarding cancer drug Zejula. And the FT reports that BioNTech is booking huge profits with €2.8 billion in the last quarter alone from its Pfizer collaboration vaccine. The company’s expected €15.9 billion annual revenues will enable big investments into its cancer, TB and malaria research.
Cronyvirus and Coronamillions update
I touched last week on Lord Bethell’s risible game-playing about his ‘lost’ WhatsApp and text messages. The Guardianrevealed this week that the Information Commissionier’s Office has woken up and is going to launch an inquiry into this. Entertainingly, Abingdon Health’s SMT gamely tell the paper that they have no record of texts or WhatsApps: it feels very much as if Rowena Mason has some more to come on this. This is a rare example of Labour having done some opposition effectively.
The Good Law Project is behind the above, of course; likewise, this Times piece on the Government’s imminent-ish release of the names of the VIP lane fast-tracked PPE companies.
The bonfire of former PM David Cameron’s reputation got a fresh burst of oxygen this week, as the Sunday Timesrevealed that US biotech firm Illumina, for whom the ex-PM was lobbying, won an uncontested £123 million contract with DHSC’s wholly owned subsidiary Genomics England after Mr Cameron wrote to ex-Health secretary Matt ‘Alan’ Hancock on its behalf.
The Mail had a good expose of the scandalous situation with Randox private Covid19 tests. Classic market failure, as is the private PCR testing market overall. Tests are half the price or less in mainland Europe. Still, Brexit means Brexit …
Other important things
Would appear here.
Recommended and required reading
Very good Ed Yong long read for The Atlantic on what happens next with the pandemic.
Barney Calman of the Mail writes about NHS England’s counter-productive and failed efforts to block FOI research into the rate of hospital-acquired Covid19 infections.
Useful thread from Adele Goyer on the latest ICNARC data about intensive care admissions and outcomes.
Good piece by Nuffield Trust’s Billy Palmer on the finer details of the NHS pay settlement.
The FT can’t get enough of lunches with health folk, it seems. This one, with Pfizer CE Albert Bourla, is a fun read.
There just happened to be a Mail journalist and a photographer present when Alan went to Cornwall on holiday. What are the chances, eh? “He is reportedly already plotting his ministerial comeback”. You don't say.
The fragrant Julian Patterson’s fine form continues, with this HSJ profile of NHS Blithering chair Sir Trevor Longstay.