7 min read

Cowper’s Cut 193: It’s ‘Health Week’! Treasury Munchkins go Full Nick Berry, as new variant Omicron arrives

Cowper’s Cut 193: It’s ‘Health Week’! Treasury Munchkins go Full Nick Berry, as new variant Omicron arrives

To the considerable surprise of nobody with a brain, the policy of massively uneven international distribution of Covid19 vaccines resulted in a new variant - detected by sharp-eyed scientists in South Africa.

Currently called ‘Omicron’ (why not ‘Nu’?), it is as yet unclear whether this variant is going to escape the current vaccines, and if so, how successfully. We’ll find out in a few weeks, it seems.

Until then, the Government responded with travel restrictions and the reintroduction of facemask mandates for shops and public transport (the latter measure will only make a difference to the hard of thought). Pubs and restaurants are exempt: thank goodness none of them have low-quality ventilation in these cold winter months.

Inevitably, Omnicron has arrived here.

It’s a good thing we’ve seen no concerted efforts by any major UK national political party to weaponise mask-wearing for partisan purposes, eh? I’m sure members of the fraternal and convivial community will be just fine. Perhaps.

The PM’s constant lionising of the Vaccines Taskforce took an interesting turn this week, when Dame Kate Bingham’s successor Clive Dix gave a stinging interview in The Observer. Mr Dix said the UK was no longer “on the front foot” in tackling the pandemic: “I wrote a very specific proposal on what we should put in place right now for the emergence of any new virus that escaped the vaccine. That was written and handed into the [vaccine taskforce] at the end of April when I left. I haven’t seen a sign of any of those activities yet.

“I sent a note to No 10 [in May] saying I think this is still an emergency and it should be dealt with urgently – and I want it on public record that you’ve got my proposal. But I didn’t even get a response to that. I prodded the government and said, ‘What’s going on, because we need to do this’. I don’t see any of that going on.”

“I think it’s time to ask the vaccine taskforce and the government, what is your plan for an escape variant? What is your plan for resilience for the future? Let’s see it because I think the country needs to know”.

Meanwhile, the Great Dame herself claimed in this Times piece that the British Government and state are driving away medical innovators.

Ahem. Still, no doubt the success of the PM’s speech to the CBI will have buoyed him up nicely.

Treasury Munchkins go Full Nick Berry
This has been a good week for our dear friends the Treasury Munchkins, with the successful Government votes on the revised and diluted social care funding proposals, and against the Jeremy Hunt amendment to the new Health Bill which would have put a legal requirement for the Department For Health But Social Care to publish biennial reporting of workforce plans and the numbers in training.

Some people will interpret this as ‘the Treasury is back!’. Those who follow political journalism will have noted the various briefings from Team Sunak this week about the Chancellor’s fatigue with the chaos of the Number 10 operation: prominently this one to The Times.

Realistically, in both of these cases, the practical upshot will be that in return for these short-term political gains, The Treasury Munchkins have gone Full Nick Berry on us: ‘Every Loser Wins’ is now their official theme tune.

You can’t do even the most exciting new diagnostic and operation hubs if you haven't got the workforce. NHS Digital’s latest figures show the vacancies are over 100,000.

Morale matters, too: Royal College of Emergency Medicine President Katherine Henderson warned HSJ that ministerial ‘gaslighting’ of staff that all is back to normal was not helpful. While she suggested that the intentions of those making such comments may be “well meaning”, the situation requires ministers and NHSE leaders to be “humble and transparent about the scale of the problem [facing the NHS] at the moment. The scale of the problem feels quite overwhelming, and the kind of ‘move along, no story here’-type attitude I think is not great for the people working in healthcare. They need to feel heard”.

Here comes Health Week
We also learned that this is to be a ‘Health Week for the Government, with announcements due on plans to tackle the backlog.

Amusingly, the Government plans briefed range from the gimcrack, such as NHS Reservists to the tawdry, such as a plan for patient activation. It’s worth noting the ‘The Saj’ tweeted about ‘NHS Reservists’ with a graphic that has a ‘Conservatives’ logo. Interesting to see the NHS becoming a wholly-owned subsidiary of the Conservative And Unionist Party: that must have cost NHSE a fair bit in bungs, but on the upside, presumably now Pope Amanda gets to be Tory Party Treasurer and then bags a seat in the Lords?)

We will of course await the actual details of these, but one of the funniest proposals was to allow patients to book their own appointments in secondary care once their GP agrees a referral is needed. (HSJ has covered ‘patient-initiated follow-up’ for some time now.) That is such a great idea: perhaps they could give it a snappy name like, oh, ‘Choose And Book’?

‘Health Week’ promises to bring us the elective recovery plan. Yes, I’m excited too.

Single point of blame
As well as ‘Health Week’, the briefing people have been telling HSJ that the Government’s new integration White Paper may look at singe leadership models for accountability and planning across health and social care.

At one level, you can see this as Downing Street anticipating the problem of whom to blame for failures to deliver. At another, given the, erm, developing and emerging nature of the new Integrated Care Systems and their variable ratings from NHS England, this might be a “courageous” move, in Whitehall-speak.

Lay down your Gery tune
The DHBSC also published the Wade Gery review, which as HPI revealed, recommended the absorption of NHS Digital and NHS Kiss into NHS England. (NHS Digital boss Simon Bolton’s Twitter thread about this is worth a read.)

The WaG Review is a splendid thing. It tells us that “NHSEI needs to ‘transform the way it transforms’.”, which is an enormous inspiration to us all at this challenging time.

The WaG Review threatens that this transformation of transformation itself will mean “significant changes to ways of working, culture and behaviour, resource allocation, and funding”. So that’s nice.

It also vows that this new transformation factory will offer “scalable capability that integrates clinical, operational and technological resources to transform patient pathways and service delivery … agile change methodologies …with small, focused multi-disciplinary service teams … Individuals will be part of service teams with day-to-day oversight from the Transformation Factory leadership, but will be drawn from other functions (for example technology, operations, clinical)”.

Now I’m reassured.

What, then, should we expect when this changes nothing at all in the real world, and we then need to transform this transformation of transformation? Exciting times lie ahead, in a manner of speaking.

Oh, and speaking of reviews, the Messenger Review TORs finally came out, as did this letter, effectively telling the service ‘I’m sure you're all trying jolly hard’. Meh. The Messenger remit looks like a compendium of NHS management review clichés: they’re all there, apart from ‘God Is Love’ and ‘Please Adjust Your Dress Before Leaving’.

But change is well under way around the politics. The PM’s Unofficial Spokesman did a bit of actual proper and un-briefed-looking journalism. BBC News has started to prominently mention the bullshit of the Government’s 40/48 new hospitals claims.

These sorts of things don't happen to a Government that is still in the ascendancy or dominance.

The creaking system
Nearly two thirds of A&Es across the UK had ambulances waiting to transfer patients every day in the past week, according to a new survey from the Royal College of Emergency Medicine. Their latest survey covers the period 8 November to 14 November 2021 and was sent to clinical leads in Emergency Departments across the UK: it saw 70 responses.

The NHS mandates that ambulance handovers ought to be reliably completed within 15 minutes of arrival, but 61% of Emergency Departments in the survey reported struggling to meet this standard every day.

Meanwhile, analysis from James Illman and Lawrence Dunhill of HSJ reveals that none of the ICSs given extra funding for delivering increased activity over their 2019 level has achieved that target. While the twelve ICSs are thought to have agreed to target 120% of their pre-pandemic activity levels, none had managed to even equal it.

This is as significant as it is unsurprising, and it is very unsurprising indeed.

Cronyvirus and Coronamillions update
I mentioned Baroness Mone’s massive mis-statements in last week’s big ‘C&C’ round-up: the FT this week obtained emails relating to this that cast considerable further light on the matter. Not light that flatters Baroness Mone, moreover.

The Times followed this up, noting the shadow Scottish secretary’s call for Baroness Mone to refer herself to the Parliamentary Standards watchdog for investigation. Naughty watchdog: down, boy! Gosh, did disgraced Randox lobbyist and former MP Owen Patterson’s ignominy count for nothing?

The Independent revealed new concerns about the accuracy and timeliness of results from a second lab owned by Immensa, the firm whose wrong results drove a Covid19 spike in the south-west earlier in the autumn.

The Good Law Project spotted discreperancies between the account of Lord Feldman, (PR firm Tulchan’s boss) account of his involvement with the VIP fast lane and documents published about who the referrers were for various companies (a certain Lord Feldman, amazingly. The GLP are, of course, pursuing this.

Getting the Bill (Health and Social Care)
Following the refusal of ministers to accept the Hunt amendment, the Bill passed its second reading in the Commons, and now passes to the Lords.

Not co-incidentally, Mr Hunt’s Health And Social Care Committee has just launched a new inquiry into NHS workforce issues.

Other important things
Would appear here.

Recommended and required reading
Interesting analysis from the FT’s Chris Giles and Sarah Neville of the UK’s rising excess death rates: not, in their view, readily explicable by Covid19 effects.

Good piece by Economist health policy editor Natasha Loder on the post-truth pandemic.