Cowper’s Cut 192: Political bankruptcy, un-masking events and the masochism tango
“Nothing works without staff. It’s unfair to ask staff to work under this level of pressure forever. We need to support our current staff now, recruit more staff, including from abroad, and we need a long-term workforce plan”
NHS England chief executive Amanda Pritchard, interviewed on BBC Radio 4 Today programme, 16.11.2021
(On overseas recruitment) “Unbelievably inefficient and also wrong and just bizarre … stupid”
Health Minister Gillian Keegan, Conservative Party Conference October 2021
Imagine my surprise to learn from HSJ that the Infrastructure and Projects Authority downgraded the Government’s fantasy nonsense about 40/48 new hospitals (which as I’ve been pointing out incessantly, is actually six) to a ‘red’ risk rating of being delivered by 2030. The financial downgrading of plans for submission was also spotted by HSJ earlier this year.
In an interesting footnote to the topic of ‘new hospitals’ production, the liquidators for Carillion are reportedly suing the company’s auditors KPMG.
The forthcoming public Covid19 inquiry next Spring will be sighted on the National Audit Office’s new report into the Government’s pandemic preparedness. It concludes that “a cross-government review of pandemic planning arrangements found that most plans were inadequate to meet the demands of any actual incident … the government did not act upon some warnings about the UK’s lack of preparedness from its past pandemic simulations”.
The NAO report also finds that “preparations for EU Exit had significant benefits in responding to the pandemic but diverted resources from other risk and contingency planning”.
Social care un-resolved in Tory political base-jumping
Torsten Bell of the Resolution Foundation spotted this week’s update on the social care reforms. Bell notes that “the big change is to reduce how much protection the cap provides to those with fewer assets, by making it less likely that they could benefit from the cap … f you receive any help from government towards your care costs via the means test (because you are poorer), it's only the amount you yourself pay that counts towards the cap
“Andrew Dilnot explicitly rejected this approach (hence why the govt is needing to amend the Care Act) because it undoes the purpose of the means test = ensuring those with fewer financial resources make a smaller contribution towards their care costs than those with more.
“Where would this change leave us? With the cap's benefit for those with under £100,000 of assets much reduced - this techy-sounding shift could double your care costs if you've got around £9,000; but makes no difference to someone with £500,000 who gets almost all their assets protected.
“The means test will still make a big difference to this group with fewer assets. But if the exam question is whose assets are being protected by this reform, the answer on the basis of this change is much more distinctly the asset-rich than previously thought. The Government almost certainly already intended to make this change when making the announcement in September - i.e. today is just when the outside world found out the policy had changed”.
This is a blatant piece of political base-jumping by the Conservative And Unionist Party: jumping away from its new political base in the ‘red wall’ seats that gave it the current commanding majority, and towards its traditional, wealthier base.
Andrew Dilnot, whose 2011 work informed the policy and ex-DHSC civil servant and Kings Fund policy director Sally Warren gave evidence to the Treasury Select Committee regarding this base-jumping. Neither was impressed.
The PM’s marital ‘buyer’s remorse’ and The Streisand Effect
‘If at first you don't shoot yourself sufficiently damagingly in the foot, try; try again’ seems to be the Boris Johnson administration’s revealed-preference motto.
Reports emerged on pro-Conservative social media at the end of the week of the PM taking legal action against the anti-Brexit New European newspaper. This followed that paper’s report of remarks Mr Johnson allegedly made at the Telegraph reunion dinner (the one immediately preceding the bizarre show of swiftly-rescinded Government support for disgraced Randox lobbyist and former Tory MP Owen Paterson).
This New European story reports that the PM, asked about his marriage to Carrie Johnson (née Symonds), expressed “buyer’s remorse”.
NE editor-in-chief Matt Kelly reports that the PM’s director of communication Jack Doyle telephoned him that night, to advise him verbally that the PM would sue the newspaper for defamation. Mr Kelly’s response, standing by his story, is here: it includes a report that Downing Street is now denying any threat of legal action. Mr Kelly states that he has phone records, including text messages, that can verify his account.
Ooops, Downing Street.
Big, big ooops.
The Streisand Effect is defined as “a phenomenon that occurs when an attempt to hide, remove, or censor information has the unintended consequence of increasing awareness of that information, often via the internet”. That neatly describes this bid to ‘threaten’ litigation for defamation quite neatly.
Perhaps the phenomenon of endless, unforced and utterly avoidable masochistically shooting oneself in the foot will come to be known as ‘The Johnson Effect’?
The Masochism Tango
The classic Hemingway line about how one goes bankrupt (“two ways: gradually, then suddenly”) is well under way with the Johnson administration. Taking the high road to political bankruptcy has rarely in my lifetime seemed so self-inflicted.
In March last year, I proposed that “the first rule of Political Lying Club is that nobody cares about political lying any more, until they do again”. It feels very much as if people are starting to care again.
Mr Johnson is dancing ‘The Masochism Tango’ with his party and his partisans: he just doesn't realise it yet.
An un-masking event
Monday began with an update on Covid19 on the Parliamentary estate from Guardian political correspondent Aubrey Allegretti that “infection rates on the estate were *four times* higher than the London average in late October. And there have been a ‘small number of cases’ of people with symptoms still coming into work. Covid rates in parliament have since fallen - but are still double those in London”.
This follows on from PM Boris Johnson’s repeated refusal to follow requests to comply with the mask-wearing protocol on his visit to a Northumbria NHS hospital last week. This was raised at a directionless Downing Street briefing on Monday afternoon, and the PM claimed "I wear a mask wherever the rules say I should". Ahem, ahem. That is a blatant lie.
New NHS Pope Amanda Pritchard was asked about the PM’s refusal to wear a mask on a hospital visit in Northumbria, during her first full-length broadcast interview this week. She could only muster “I wasn’t on the visit, so I don’t know the ins and outs of what happened there”: a not-quite-reassuring answer to an easily-anticipatable question.
Dangerous Liaison over NHS workforce
At the very end of the PM’s Liaison Committee appearance (16.54) , Jeremy Hunt asked PM Johnson about his amendment to the Health Bill to set up a requirement to independent estimates published every few years as to how many doctors and nurses should be trained.
The PM claimed to be on track to deliver 50,000 more nurses by the end of the Parliament and clamed “we are working as hard as we can to get more GPs … whether our campaign would be helped by what you're proposing, I can't say … I’m not ruling your idea out … we’ve got record numbers in the NHS”.
Hunt followed up asking whether the yet-to-be-settled HEE training budget will be cut in real terms. “I’m sure that within the NHS budget, there must be funds for health education”, the PM claimed.
Abolition of HEE and NHS D/X into NHSE
‘Cowper’s Cut’ this week EXCLUSIVELY (no idea how that appeared in bold capital letters, tbh) revealed that NHS England will be taking over not only NHS Digital and (for the first time, explicitly) NHS Kiss, but also Health Education England. HEE was created by secondary legislation (effectively, a statutory instrument), and so it does not need primary legislation to abolish/relocate it.
All of these relocations into NHS England give the Secretary Of State For Health But Social Care direct operational control once the new Health Bill passes into law with its ‘more Matt Hancock’ provisions.
For HEE in particular, it also moves the budget for new staff into the overall set NHSE budget ringfence. This change signals the fact that our dear chums the Treasury Munchkins have definitively won the skirmish over funding a workforce plan: this means that the current NHS and care workforce crisis risks becoming endemic.
The creaking system
The Royal College of Emergency Medicine’s new report ‘RCEM Cares: The Next Phase’ reveals that revealed that 4,519 patients died as a result of crowding and 12-hour stays in A&E departments in England in 2020-21. This complements NHS England’s analysis that one in 67 patients staying in A&Es for 12 hours comes to excess harm
Now that NHS England no longer publish the relevant data, FOI work by The Times reveals that short-notice cancellation of urgent operations remains a huge problem.
King Harvest Is Surely Come
Deaths are running ahead of the 2015-19 average by 10%, actuary Stuart Macdonald points out of the latest ONS data. He adds, “there’s typically much less variation in mortality rates from year-to-year in Autumn, compared to our more volatile winters. It’s unusual to see such significant excess mortality at this time of year”.
Cronyvirus and Coronamillions update
A list of Conservative politicians who fast-tracked firms into the Covid19 procurement VIP ‘fast lane’ was leaked to Politico this week. Lord Feldman, whose lobbying firm Tulchan’s client Bunzl Healthcare, is on the list.
So is The People’s Partridge: Alan helped four firms. His good chum, former Downing Street chief aide Dominic Cummings helped one; and prominent MPs Julian Lewis, Steve Brine, Esther McVey and Andrew Percy are also mentioned in dispatches. So did former RCN chief Dame Donna Kinnair, and Emily Lawson’s name appears repeatedly.
The list shows that no other political party successfully referred companies via this fast-tracked route.
Commenting on this, Good Law Project boss Jolyon Maugham notes that “PPE Medpro was founded by the former business associate of Conservative Peer Baroness Mone. It won two huge contracts, worth £200 million, just weeks after it was set up. A lawyer for Baroness Mone previously claimed that she hadn’t “had any role or function in the company, or in the process by which the contracts were awarded”. The leaked information does suggest, however, that she was the source of the referral of PPE Medpro to the VIP lane.
“Michael Gove referred Meller Designs, the firm of Conservative donor David Meller, to the VIP lane. The company subsequently landed over £160 million in PPE deals.
“Lord Feldman referred SG Recruitment to the VIP lane. The Conservative Peer Lord Chadlington sits on the Board of its parent company, Sumner Group Holdings Limited. They landed £50 million in PPE contracts”.
This is starting to kick off, with the Commons debate about Randox contract hearing from Health Minister Gillian Keegan that "we have been unable to locate a formal note of that meeting”, referring to the phone call between then-Health Minister Lord Bethell, Owen Paterson and Randox soon after the company was awarded a £133 million Covid testing contract.
In what looks like legally-adviser wording, Ms Keegan then clarified, “I just want to make it clear what I said: we have been unable to locate a formal note of the meeting. That is what I have been told so far. That doesn't mean there isn't one. It has been unable to locate one. But of course, everything we have will be put in the House of Commons Library".
Share options in AI firm C3.ai offered to its ex-consultant ‘The Saj’ (and appropriately declared by Mr Javid in the Register of Members’ Interests) have come onto the political agenda.
Serco issued an upwards revision to its profits forecast as a result of its Test And Trace contracts. By co-incidence, news emerged this week in The Guardian that TAT is still spending over a million pounds a day on external consultants. Test And Trace was set up in May 2020: it is now nearly December 2021. Andrew Gregory reveals that the “very detailed ramp-down plan” UK Health Security Agency CE Dr Jenny Harries described to MPs in July is far from working. Gregory’s research shows that “at the end of October it (TAT) employed 1,230 consultants. Test And Trace has average daily contractor rates of £1,100, potentially equating to £1,353,000 a day. The ratio of consultants to civil servants in NHS test and trace in September was 1:1, separate data shows, despite a target set a year ago to reduce the ratio to 60%”.
And research suggests that the previously-covered failures of testing at the Immensa lab serving the south-west probably caused thousands of extra Covid19 infections because of the false negative results issued.
Getting the Bill (Health and Social Care)
The remaining Commons report stage of the Bill is due to conclude today and on Tuesday. Cue the usual gubbins from the usual suspects about fictional NHS privatisation. Yawn.
Health Secretary Jeremy Hunt this week tabled an amendment to the Health and Care Bill which would force the Government to publish independent workforce projections biennially to ensure the pipeline of clinical staff in training meets future demand.
The Hunt amendment is supported by 38 MPs – half of whom are Conservative, with 8 select committee chairs and all the opposition parties.
Currently, there is no public data on whether England is training enough healthcare workers to meet expected future demand. With high levels of staff burnout post-pandemic; workforce shortages in every specialty; and Health Foundation projections showing that an additional 4,000 doctors and 17,000 nurses are needed to clear the backlog, this proposal - if it is passed, and backbench amendments usually are not - would commit to bring rigour and independence to workforce planning for the first time in the NHS’s history.
Other important things
Would appear here.
Recommended and required reading
The Health And Social Care Select Committee is launching a new inquiry into ‘The Future Of General Practice’. Details here.
Theranos boss Elizabeth Holmes continues to give evidence in her trial in the US.