"We can't control the spread of the virus. The virus is doing what it's doing, and we have to react to that."
Chancellor Rishi Sunak, BBC Newsnight
It seems as if there’s a competition under way: an ‘arsehole-off’ between the various Munchkin communities of the Treasury; the Department For Health But Social Care; and NHS England.
As last week’s ‘Cut’ outlined, our dear chums the Treasury Munchkins set the bar high with their shenanigans on recovery funding, social care and ongoing plans to require NHS “efficiency savings” (cuts, in layman’s terms).
It surely brings a swell of NHS patriotic pride to see our sector respond brilliantly to this challenge. The first response was from the DHBSC Munchkins, who (we learned in Dave West’s cracking HSJ story) have issued a New Hospitals Programme Communications Playbook.
Great word, ‘playbook’. Playbooks are for children, evidently.
Also, it seems, for the kind of idiot who believes that, by mandating local NHS organisations to use our taxes to tell us demonstrable lies, they somehow become Top Machiavellians/thrusting characters from ‘The West Wing’.
We are all 40 new hospitals now
To get the flavour of this DHBSC-mandated dishonesty, it’s worth quoting a chunk of this leaked ‘playbook’: “the schemes named in the announcement are not all identical and vary across a number of factors. However, they do all satisfy the criteria we set of what a new hospital is and so must always be referred to as a new hospital”.
“Under the heading ‘Definitions of a new hospital’, it says this can include “a major new clinical building on an existing site or a new wing of an existing hospital, provided it contains a whole clinical service, such as maternity or children’s services; or a major refurbishment and alteration of all but building frame or main structure, delivering a significant extension to useful life which includes major or visible changes to the external structure”.
“The guidance says where trusts are talking about the programme, they must use the government’s line about 48 new hospitals. Its suggested “short description” of the programme is: “The government has committed to build 40 new hospitals by 2030, backed by an initial £3.7bn. Together with eight existing schemes, this will mean 48 hospitals by the end of the decade, the biggest hospital building programme in a generation.
“Under a heading “background lines - if needed” — indicating they should be given to journalists but not attributed to a spokesperson — the document adds: “The government has committed to the delivery of all 48 hospitals by 2030 — and these plans remain on track”.”
Yes. It is much, isn't it?
If we give up on empirical reality and allow basic lies to become accepted, then we become complicit in this. “We are all 40 new hospitals now”.
Except we aren’t, and they aren’t. It was interesting to note (with thanks to Dave West) that the Chartered Institute of Public Relations being very clear that their members in NHS communications should have no part of this, with their President Mandy Pearse stating “we remind members that the CIPR code of conduct requires them to maintain the highest standards of integrity whilst dealing honestly and fairly with the public”.
So, would members of the NHS England Munchkin community be overwhelmed by this fine effort from DHBSC?
Worrying about a collapsing RAAC roof? Don’t be “sensationalist”
I am pleased to report that they would not.
Stepping up to the plate with world-class stupidity, the Eastern Daily Press’s smart FOI revealed that NHS England’s communications folk put on written record that Caroline Shaw (Queen Elizabeth Hospital King’s Lynn Foundation Trust’s chief executive) “has been very vocal about the state of the hospital’s roof in recent months, and the NHS England media team has been concerned with the sensationalist tone they’ve been taking in the media”. HSJ followed this up.
Sigh. Buildings with reinforced autoclaved aerated concrete (RAAC) beams or planks in their roofs are at actual risk of collapse, as a cursory internet search shows. ‘Cut’ touched on this issue last week, too.
So, what’s the latest news on Covid19’s impact on the NHS and society more widely?
It’s not looking great, as intensive care doctor Rupert Pearse notes. The official data shows that infections, admissions, ventilations and (lagging indicator) deaths are all up this week. In Pearse’s words, “anxiety about ICU beds is growing”.
Obviously, rising Covid19 acute workload prolongs infection control and waiting list backlog capacity reductions. Speaking of which, the new ‘Waiting For Care’ long read from the Health Foundation is an excellent piece.
A major study in the Lancet shows how the Delta variant is associated with higher hospitalisations than ‘classic’ Covid19. Julia Hippsley-Cox and colleagues’ BMJ review proves the importance of vaccinations given the higher rate of thrombosis problems from Covid19 infections.
It’s worth looking at this ONS piece on Coronavirus and the social impacts on Great Britain.
Adele Groyer provides “a summary of the ONS deaths data to week ending 13 August. 1,270 more deaths were recorded compared to the 2015-19 year average. That’s 14% higher. Year-to-date there have been 364,655 deaths recorded; 8% higher than the 2015-19 average.
“There are 571 deaths where COVID was mentioned on the death certificate this week. 9-out-of-10 deaths with COVID mentioned had it listed as a underlying cause. So, again this week, COVID deaths have increased and also deaths from other causes are above the 2015-19 average.
“There is typically much less variation in mortality rates from year-to-year in summer, compared to our more volatile winters. It’s highly unusual to see significant excess mortality in week 32. In last five years the range is 8,945 to 9,319. There were 10,372 this year.”
Is vaccine-acquired immunity waning? The data shows some reductions in the level of protection, as this decent BBC News piece summarises, but realistically, the confounding effect of August (school holidays in particular) mean we won't fully know the real-world consequences until the end of September.
The creaking system
Following on from last week’s ‘Cut’, it’s well worth reading GP Nick Grundy’s reflections on the current ICS proposals.
Referencing Sally Gainsbury’s strong piece for the Nuffield Trust, Nick suggests that “ICSs need to acknowledge this financial gap and make plans to tackle it. No signs they will do so far! But they need to remember that NHSE put ICSs in place explicitly so they could STOP the annual bailouts of hospital trusts.
“A lot to be cautious about. Also, NHS-management-haters take note: "The effective merger of NHS Improvement [...] and NHS England [...] was accompanied by a rapid deterioration in the transparency of aggregate national financial reporting on the NHS trust sector as a whole."
“This almost needs its own mini-thread, doubtless written by someone more knowledgeable than me, but reading the ‘NHS Operational Guidance’ is instructive. They expect "by 2023/24 no trust to be reporting a deficit … with funding replaced by recurrent efficiency improvements".
“These are cuts, dear readers. How large the cuts are depends on how big the current annual bailouts are: the below data (again from The Kings Fund) were *before* Covid. GP practices and the voluntary sector in ICSs seem to be the only ones who've actually run to budget annually ...”
The latest figures on workforce from NHS Digital this week show that NHS staffing shortages have stubbornly failed to miraculously disappear. (“Sensationalist” of me to mention this, I know.)
These preliminary findings from a Health Foundation review of the health and wellbeing of lower-paid NHS staff are also well worth reading.
Sexual harassment culture of the medical trades unions
Meanwhile, we learn that “in light of serious allegations of sexual harassment and after independent legal advice”, the 2021 RCN Congress is to be held online. This is concerning in the extreme.
People will remember the Romney Review into sexism and sexual harassment at the BMA, and rightly wonder what sort of culture has developed in the main medical trades unions; and how.
Oh, and why. There is certain to be more to emerge on this. The BMA’s new ‘Sexism In Medicine’ report is worth your time.
Cronyvirus and Coronamillions update
Most of the action this past week has again focused on private sector testing. The Independent’s excellent Simon Calder is excoriating on the Wild West of PCR testing.
The Times revealed that Patience Annan, an NHS doctor twice suspended by the General Medical Council, owns a coronavirus testing company that is being publicised by the government. The paper found that one firm, going by four separate names, has each one listed as a separate company on the government web page; another is owned by a doctor who has been criticised in the past for profiteering from private coronavirus tests.
The medical director of DAM Health told the Mail that his company had to resort to self-regulation because of the Government’s lack of official guidance.
The absolute basics are failing or being left undone, in other words.
So what hardcore corrective action is there?
Ooh – an open letter from the Competition And Markets Authority to the sector. That’ll fix it. Open letters invariably solve problems at a stroke.
Unfortunately for the CMA, the FT's Kate Beloley spotted their decision to close their Covid19 unit "at the start of the year, months before a crisis over rip-off travel tests prompted the watchdog’s intervention".
The former CMA chair and ex-MP Andrew Tyrie told the paper, “the CMA has been scarcely visible on this [Covid and PCRs] since closing down the task force and ending any serious attempt to promote online complaints from consumers, leaving them without the information they need to monitor the development of detriment”.
Ooops. So, did the CMA take this well?
No. Their statement wibbled, "it is wrong to suggest that changes in how we structure our Covid work have affected our ability to respond to the pandemic. Like many organisations, the CMA’s internal processes have evolved since March last year to help us deliver action more effectively. People know only too well that coronavirus hasn’t gone away yet, so tackling its impact is no longer a short term project; it is a key part of our ongoing work”.
Getting the Bill (Health and Social Care)
There is nothing much to report this week, but a couple of pieces of context came to mind.
NHS management expert Stephen Black’s piece on the new Health Bill is well worth reading; as is Michael Lambert’s excellent piece on the historical tradition of political patronage in the NHS.
Lambert’s conclusion, that “ensuring democracy, accountability, and transparency in the NHS through non-executive scrutiny is only possible through resolving larger political tensions across the service and organisation. Technocratic adjustment or a return to the past is insufficient” should be read by everyone on the Bill Committee
Other important things
Would appear here.
Recommended and required reading
A very funny New York Times read about the prices that USA hospitals and health insurers don't want their customers to see.
Thoughtful John Launer piece in the Postgraduate Medical Journal on doctors and political activism.