I won't tend to do mid-week specials, but the danger of covering CPC21 properly is of making the next 'Cut' hugely over-long, and I thought you might enjoy this. (I hope so, anyway.)
This week gave us the special pleasure of the Conservative And Unionist Party’s annual conference in Manchester. So, how was it?
Well, it was ... different. Chancellor Rishi 'The Brand' Sunak's speech was seriously incoherent.
"I believe that mindless ideology is dangerous. I’m a pragmatist. I care about what works, not about the purity of any dogma.
“I believe in fiscal responsibility. Just borrowing more money and stacking up bills for future generations to pay, is not just economically irresponsible. It’s immoral. Because it’s not the state’s money. It’s your money."
I mean, that second set of points *is* ideology. It *is* dogma. It's just ideology and dogma that The Brand likes, and thinks is retail.
Towards a numerate Exchequer
The Brand also can’t count: “since 2010, we’ve had 5 Labour Leaders, 7 Shadow Chancellors and innumerable spending pledges”.
Ahem. Labour leaders since 2010: Miliband, Harman, Corbyn, Starmer. That's four. Shadow chancellors since 2010: Johnson, Balls, Leslie, McDonnell, Dodds, Reeves. That’s six.
His self-praise for backing Brexit was curious, given his subsequent comments that “you cannot make progress if you’re pitting people against each other”.
In terms of coherence, this was matched by ‘The Brand’ praising austerity: “I’m grateful, and we should all be grateful to my predecessors and their 10 years of sound Conservative management of our economy. They believed in fiscal responsibility. I believe in fiscal responsibility”. It’s curious to see this, in a time when even the World Bank and the International Monetary Fund have come to accept that austerity policies (that they once advocated, let’s be clear) have been a massive economic cul-de-sac.
“Political accountability on performance”
Health But Social Care Committee member and MP for York Paul Bristow told an event, "the public won't forgive a government that puts up taxes and fails to get bang for buck in return", adding (according to HSJ’s Nick Kituno), “the NHS needs to deliver "considerable" savings. Not just financial, but also with regards to treatment”.
He continued with a call for “political accountability on performance", adding decisions are being made without being made without "any real accountability … I sometimes feel frustrated there's no way to influence the criteria that's being applied" with regards to decision-making.
At another event, Health But Social Care Secretary Sajid ‘The Saj’ Javid, replying to HSJ’s Dave West question, said that the Messenger leadership review differs from previous attempts in that it's going to be a "quick" report, over the next four months, and "very wide-ranging: The way it's been approached is something I don't think has been done since 1983 [The Griffiths Review, for PM Margaret Thatcher]."
Apparently, the Messenger Review's terms of reference will be out in the next week.
The sack race is back
Ahead of Mr Javid’s conference speech, The Times had been briefed a front page headline story that NHS leaders who don't cut waiting lists will get fired. The paper claims that The People’s Saj “is said to be frustrated that ministers lack the means by which to hold failing leadership to account, with hospitals enjoying considerable local autonomy. He wants the power to replace the whole leadership team in failing hospitals or to have them taken over by high-performing neighbours”.
So Mr Javid’s analysis is that NHS leaders haven't been getting the backlogs down because they haven't been threatened with being fired?
Really? Oh dear.
As the great H L Mencken noted in The Divine Afflatus, “there is always a well-known solution to every human problem—neat, plausible, and wrong”.
Among the most likely consequences of this is frantic and widespread manipulation of waiting list data.
It’s almost as if Conservative MPs never voted to a woman and man for the ‘Liberating The NHS’ Lansley reforms to decentralise and let choice, competition and clinical commissioning drive a self-perfecting system.
This is obviously a government of incompetents, who think headlines and announcements are how you do change. And this ‘policy’ has given them a big headline. The Johnson administration wouldn’t recognise a perverse incentive if it kicked them up the arse.
Which it will.
Broadly, across their conference, the Conservatives’ new rhetoric that ‘lower immigration leads to higher wages’ is going to get very interesting when it comes to health and social care.
It’s well worth having a look at the new Nuffield Trust report on overseas nursing recruitment. It states that “vacancies are widespread: there were 39,000 full-time equivalent nurse vacancies by mid-2021, representing a 10% vacancy rate. The equivalent figure for doctors is 7%. The 2019 NHS Long Term Plan committed to reducing the nursing vacancy rate to 5% by 2028. Later that year, the government pledged to increase the number of NHS nurses by 50,000 by 2025”.
The austerity decade that Chancellor Sunak lauded in his speech put the NHS into the bad state it was in before Covid19. That was the lowest sustained rise in funding in its history, which put the NHS into its poor and backlogged and debt-ridden state even before Covid19 hit.
Oh ... it was heroically bad. The applause of the faithful at the entry and during the initial clap-traps struggled to reach the giddy heights of politeness. And it was no more emphatic at the end.
Mr Javid asserted that "as Conservatives, we will never see state controls as the default". Unless, of course, he chooses to sack entire NHS management teams, as briefed to The Times.
There was further unmitigated nonsense when he claimed that "in the past, some governments chose cash, others chose reform. That’s a false choice. You can’t have one without the other".
A passage that wil merit further invesigation saw Mr Javid let his love of Ayn Rand flow: "government shouldn’t own all risks and responsibilities in life. We as citizens have to take some responsibility for our health too. We shouldn’t always go first to the state. What kind of society would that be?
"Health - and social care - begins at home. Family first, then community, then the state". Mmmmmmm.
Referencing the forthcoming Messenger Review, The Saj told the party faithful that "two factors determine whether organisations succeed: leadership and innovation". Well, ex-Theranos boss Elizabeth Holmes – who scores on both leadership and innovation - is out of work currently. He should give her a ring.
I’ll update this after the PM’s speech tomorrow, but in advance of that, I really recommend Matthew D’Ancona’s analysis of ‘Johnsonism’ for Tortoise: it’s a proper bit of thinking about the PM’s appeal and motivation.
Oh, and HSJ's Dave West has this lovely piece on health minister Gillian Keegan criticising international nurse recruitment as “stupid ... bizarre, unbelievably inefficient and also wrong”. It is, as Dave notes, the Government's own policy.
The PM's speech
Mr Johnson's conference address was very much targeted to the faithful of Johnsonism, which is not really Conservatism (as the Matthew D'Anocona piece linked above so neatly describes).
Energetic it may have been but coherent it most certainly wasn't. Immigration is bad; except when it's good. Higher productivity economies are low-tax economies: quick, tell the French. The vaccines procurement wouldn't have been possible if we were still in the EU, which we still were during its entirety (and health is a devolved, supporting competence within the EU).
The same Government which noisily criticised the England football team for taking the knee now hymned their spirit.
The health section is no more coherent (my factual interjections in bold):
"When this country was sick our NHS was the nurse: frontline health care workers: battled against a new disease, selflessly, risking their lives, sacrificing their lives. And it is right that this Party, that has looked after the NHS for most of its history, should be the one to rise to the challenge.
"48 new hospitals (don't and won't exist); 50,000 more nurses (figure includes 16,000 who simply don't quit; won't be hit without imports, which your health minister opposes); 50 million more GP appointments (don't exist); 40 new diagnostic centres (newly re-announced; don't exist). And fixing those backlogs with real change, because the pandemic not only put colossal pressure on the NHS. It was a lightning flash illumination of a problem we have failed to address for decades.
"In 1948, this country created the National Health Service but kept social care local. And though that made sense in many ways generations of older people have found themselves lost in the gap.
"When covid broke there were 100,000 beds in the NHS – and 30,000 occupied by people who could have been cared for elsewhere, whether at home or in residential care. And we all know that this problem of delayed discharge is one of the major reasons why it takes too long to get the hospital treatment that your family desperately need (funding for Discharge To Assess is only until the end of the current financial year) and people worry that they will be the one in ten to suffer from the potentially catastrophic cost of dementia wiping out everything they have and preventing them from passing on anything to their families, and we Conservatives stand by those who have shared our values, thrift and hard work, and who face total destitution in this brutal lottery of old age in which treatment for cancer is funded by the state and care for alzheimers is not – or only partly.
"And to fix these twin problems of the NHS and social care we aren’t just going to siphon billions of new taxes into crucial services without improving performance.
"We will use new technology so that there is a single set of electronic records as patients pass between health and social care (supposed to have been done by 2020), improving care and ensuring that cash goes to the frontline and not on needless bureaucracy.
"When I stood on the steps of Downing Street I promised to fix this crisis, and after decades of drift and dither this reforming government, this can-do government, this government that got Brexit done; that is getting the vaccine rollout done; is going to get social care done" (not really).
The Dear Leader
Mr Johnson's boosterish optimism is one of the things that his fans like about him. He has become the Dear Leader figure of a party whose nominative politics (Conservative and Unionist) he evidently does not share. In D'Ancona's smart analysis, if Johnson believes in anything beyond himself, it is in a national exceptionalism and Brexitism.
As the gaps open up between his kind of rhetoric and empirical reality, it'll be interesting to observe how Stockholm Syndrome plays out within a major political party when it is in government.
I suspect it may not end well for anyone.
As so often, Spectator assistant editor Isabel Hardman has an excellent summary of what his speech delivered.