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Cowper's Cut 189: May The Force be with The Saj in talking about making NHS backlog and workforce plans

Cowper's Cut 189: May The Force be with The Saj in talking about making NHS backlog and workforce plans

What looks very much like the first terrorist incident on NHS premises took place on Sunday morning, with an incendiary bomb detonating in a taxi at 11 am at Liverpool Womens’ Hospital. This isn’t the most cheering way to start the column, so a quick gear-change to some rather spectacular news.

The Alan comeback – literary remix
The campaign to get his political comeback under way by The People’s Partridge, former SOS Matt Hancock, took a bizarre new turn with the Mail reporting that he was in talks with publishers Harper Collins about publishing a book on his role in the pandemic.

Alan told the Mail, “I have been approached to write a book, but no decisions have been made”. The paper reports that Mr Hancock “is said to want it published just before the official Covid inquiry starts in the spring. He intends to portray himself in a 'heroic light' and 'get his version of events out there' before he faces the inquiry”.

In a striking turn of events, Harper Collins took to Twitter to announce that “as we told the Mail before it ran its story about HarperCollins and Matt Hancock, we have no knowledge of such a book and are not in talks. The story is incorrect”.

The People’s Partridge appears to have suffered from premature self-congratulation.

A shame, in many ways. This grim experience of the past two years leaves us all in need of some humour, and ‘Alan Partridge – My Covid19 Heroics’ would possibly be the most bizarre artefact to emerge from the pandemic.

The Randox inquiry?
Further to my coverage of the Owen Paterson / Randox affair last week, the topic regained political saliency in Labour leader Sir Keir Starmer’s Commons speech on Monday on the issue of political corruption and Parliamentary standards.

Starmer said that “the prime minister must commit to a full and transparent investigation into Randox and government contracts. We know that Randox has been awarded government contracts worth over £600 million without competition or tender. We know that he [Owen Paterson] lobbied for Randox. We know that he sat in on a call between Randox and the minister responsible for handling health contracts.

“Against that backdrop, there is obviously a concern that the use of taxpayers’ money and the effectiveness of our pandemic response may have been influenced by paid advocacy from the former Member for North Shropshire. If the Prime Minister is interested in rooting out corruption, he needs to launch a full investigation. If the Prime Minister is interested in restoring trust, we need full transparency, with all the relevant correspondence published—no ifs and no buts”.

In a remarkable turn of events, Times Radio’s Tom Newton Dunn reports that Conservative backbench MPs report that the Government’s whips are saying that chief whip Mark Spencer “was NOT the instigator of last week's disastrous motion, but he was following direct orders from the PM”.

Once the Whips are briefing against Number 10, as Newton Dunn notes, things have gotten very interesting.

The halo brand?
A recent public opinion poll by Engage Britain shared with The Times shows that those surveyed had more favourable views of the Health And Social Care Levy (coming in April 2022) when it was represented as a means of protecting wealth inheritance than when it was presented as more money for health and care. The net approval rating for protecting inheritances was 42%; that for more health and care funding was 24%.

Honesty, ambition and no plan
It's been a good week for the Inverse Effectiveness Law in NHS leadership communications. Power-posing Sajid Javid gave this speech to an NHS Confederation event. It was … well, different.

The Saj has “led six departments”, you know. (Nothing about where he led them.)

"This is a new era for ICS leaders after the Bill".

The Bill is still in committee.

It gets better: “we’ve never been more integrated. The way, for example, we’ve worked across traditional barriers to vaccinate the country against Covid-19”.

That was co-ordination, incentivisation and planning. It was not integration.

“The way that we’ve got data pumping through the arteries of our healthcare system. And the way we’ve simplified so many staff processes – from registering overseas doctors to streamlining appraisals”.

The Saj there, revealing how few front-line clinical staff he’s spoken to in any detail.

“For our NHS leaders, the pandemic has been like sending elite air force pilots into space. Your knowledge, discipline and experience have helped you thrive in extreme new circumstances”.

Ah. Right. Now managers are astronauts. I mean, I know some think they’re space cadets, but …

“It’s proof – if proof were still needed – that integration must continue to be our watchword and Integrated Care Systems are the right way forward”.

Proof that integration works in practice remains to be seen, as the recent paper by Lewis and colleagues fairly definitively showed. I know you all pay close attention, but this is from Cowper’s Cut 187: “The International Journal of Integrated Care publishes a key review by Richard Lewis and colleagues. ‘Integrated Care in England – What Can We Learn From A Decade Of National Pilot Programmes?’ concludes that “ while staff were generally positive about their achievements, pilots had mixed success especially in reducing unplanned hospital admissions. Common facilitators to achieving pilots’ objectives included effective senior leadership and shared values, simple interventions and additional funding. Barriers included short timescales, poor professional engagement, information and data sharing problems, and conflicts with changing national policy”.”

Still, we should definitely pay MPs more. Thank goodness that The Saj has been able to focus his laser-like intellectual brilliance away from advising J P Morgan and onto the NHS so effectively.

The new Pope of NHS England, Amanda Pritchard, wrote this bizarre piece for HSJ. The very structure of it was strange and poorly-chosen. Starting the article with the 'My first 100 days' emphasis, at the current time of pressure on the system, is not sensible. Frankly, nobody cares about that just now.

If you were going to write such a piece right now, then you’d start with the pressure numbers. You’d open with observing empirical reality. You’d then put the achievement numbers - resumption of activity over recent months.

Then you’d say a huge and heartfelt thank you.

You definitely wouldn’t go straight on to the vaccination programme, when we all know that it has not been going well: that’s why Emily Lawson was brought back from Number 10.

The key point of writing such a piece right now for the healthcare leadership trade press would need to be ‘what we are going to do about winter 21-22, given that we already, now have peak winter bed occupancy/huge ambulance delays/ ongoing primary care access issues?’

The piece does not address that crucial set for challenges.

Instead, it talks about optimism, realism, local leadership and honesty. All of which are nice things: I like every one of them.

But they are not a strategy.

I really don’t know what the point of this piece was, having re-read it three times. Tony Hockley helpfully reminds me of the 1996 ‘The NHS - A Service With Ambitions’ White Paper, which can be found here.

Julian Patterson’s blistering take-down of this frankly vacuous, tone-deaf HSJ piece is a fabulous read.

Covid19 update
I imagine that most ‘Cut’ subscribers also take Private Eye, but if you don't, I recommend that you go and buy the current issue for Richard Brooks’ vital and thorough investigation of the Covid19 procurement scandals. Brooks has clearly been informed by someone with a deep understanding of procurement issues, and this helps to contextualise the case he makes.

If Amanda Pritchard want to be taken seriously, then she wouldn’t want to claim that Covid19 hospital admissions are 14 times higher than last year, and for it to emerge that she was comparing August 2021 with August 2020. The ONS data show that this is not correct: it’s just a silly thing to have said. Of course, the claim's now been retracted, but it was spectacularly daft: August 2020 was pre-Delta variant, of course ... but also pre-vaccines.

Power-posing Health Secretary Sajid ‘The Saj’ Javid announced to Parliament that NHS staff will be required to get the Covid 19 vaccine … by Spring 2022. The DHBSC’s impact statement suggests that this may cause 73,000 staff to quit. Data suggest that 126,000 NHS, social care and private sector staff remain unvaccinated: the impact assessment shown to The Times suggests that it is believed 73,000 will not comply and be forced to quit.

The FT reports that AstraZeneca is moving its Covid19 vaccine from the non-profit phase into for-profit, on the basis that covid19 is now endemic.

The creaking system
The Independent’s Shaun Lintern (soon to be Sunday Times health editor) has a worrying leak from the Association of Ambulance Chief Executives. The body reports that tens of thousands of sick patients are being harmed as a result of ambulance delays outside hospitals. The report features examples of severely ill patients not being treated properly; being forced to go to the toilet in ambulances; and being denied food and drink, as well as antibiotics and fluids.

On the eve of this month’s national waiting time announcement, the NHS Confederation released a worrying if unsurprising survey of its members to The Guardian. It emphasised that patient safety is at “unacceptably high” risk. It seems that The Saj’s assertion that “we don't believe that the pressures currently faced by the NHS are unsustainable”may not age well.

The latest NHS England waiting list data, perhaps predictably, showed a new high of over 5.8 million, and two-year waiters  up by 3,000 in a month. Emergency care waiting times have also deteriorated. As usual, the analysis by Insource’s Dr Rob Findlay is an essential read.

East Of England ambulance trust’s entire comms infrastructure with its crews went down for what seems like most of a day, HSJ reported. A patient safety risk much?

No plan
As I wrote a few weeks ago, we are in the extraordinary position - in the middle of a real NHS crisis and as waiting lists head inexorably up towards six million - of having no workforce plan and no backlog plan. SOS ‘The Saj’ is merely talking about making such plans.

Sajid Javid’s contribution to current NHS performance is having a series of regular ‘bollockings’ meetings with NHS England boss Amanda Pritchard. Perhaps they make him feel powerful: who knows?

Is ‘The Saj’ doing anything else? Oh yes: he’s also re-announcing to the Telegraph the appointment of Sir Michael Barber to help on the backlog/performance issues. Barber, former head of the Number 10 Delivery Unit under PM Tony Blair, has been advising the Government since earlier this year, as news reports from April confirm.

The Force – not actually a real thing, Saj
I’m starting to wonder if noted ‘Star Wars’ fan The Saj (photographed with his then-number-two Rishi Sunak at the premiere of ‘Star Wars - The Rise Of Skywalker’) actually believes that public sector reform is driven by The Force.

Or as an Ayn Rand fanatic, the force of an individual's will.

If ‘The Saj’ believes in either of those fictions as likely solutions to the workforce and backlog issues, he will be very disappointed.

This extraordinary advertorial piece about Spire Healthcare in the Telegraph does not, in fact, seem to be an advertorial. I know it’s the Boris Johnson Fanzine these days (a declining market, of course), but I’m old enough to remember when the Telegraph used to be worth buying for the sports writing.

Cronyvirus and Coronamillions update
The big story this week was The Sunday Times’ revelation that Covid19 testing firm Cignpost Diagnostics (a government-approved Covid19 testing supplier, which trades as ExpressTest) is being investigated by the UK’s Information Commissioner’s Office (ICO) and the Human Tissue Authority over its plans to sell swabs containing customers’ DNA for medical research.

Documents from the firm said it intended to analyse the samples to “learn more about human health”; to develop drugs and products; or to sell information to third parties.

I actually rather liked TUC general secretary Frances O’Grady’s suggestion that one positive response to the current wave of scandals would be for the Government to assemble a Domesday Book of government contract.

The Good Law Project revealed this week that Stroud MP Siobhan Bailie’s public denials of having referred firms to the Government’s VIP fast-lane were untrue. (It’s worth highlighting the organisation’s public apology for making an error in following legal procedure over disclosure of a statement in court in their case against Abingdon Health and DHBSC.)

Getting the Bill (Health and Social Care)
It’s off to The Lords next, perhaps before Christmas.

Other important things
Would appear here.

Recommended and required reading
The Organisation for Economic Co-operation and Development’s regular ‘Health At A Glance’ survey has released its 2021 update.

The Sun has a story on the NHS spending £350,000 a year on removing objects from people’s anuses/rectums. Given the state of NHS staff morale, this seems like a modest sum to bring some laughter to staff in A&E and radiology.

An interesting FT article on the need for new models of primary care.

Intriguing Health Foundation piece on agility as the missing ingredient for NHS productivity

Johnson and Johnson is selling off its consumer business to focus on innovation.