Cowper’s Cut 195: From omnishambles to Omicron
If you thought that the Government’s Health Week last week was A Triumph, the Johnson administration managed to trump it in their Crime Week these past seven days.
There was the revelation by ITV News that the illegal parties at 10 Downing Street were open secrets to the most senior people in the building. There has been genuine public anger at 10 Downing Street holding a party on 18 December 2020 that was illegal under the then-prevalent Coronavirus legislation, as the Downing Street Twitter account confirmed at that time. This was a time when London was in Tier Three restrictions, the legislation for which can be read here.
This Downing Street Christmas party held on 18 December 2020 (first revealed by the Daily Mirror last week), was well-known throughout Downing Street, and in particular by the PM’s then-spokesperson Allegra Stratton.
Footage leaked to ITV News shows Mrs Stratton laughing and joking with Downing Street colleagues about how they would handle media questions about the party. BBC political editor Laura Kuenssberg tweeted that party attendees told her they’d been invited to attend by Downing Street political staff, as well as by civil servants.
I wrote about this for the British Medical Journal. In an interesting sign of the political times, Health But Social Care Secretary Sajid 'The Saj' Javid told the media that he'd refused to do the Government's morning media round the following day, out of annoyance about the matter.
Lied to Geidt
Even better, it became clear from the report of the Electoral Commission investigation that the PM lied to Lord Geidt in his evidence for that review of how the Downing Street flat refurbishment was funded.
Beautifully, this story emerged on ‘International Anti-Corruption Day’.
The report states that "Johnson sent Lord Brownlow, the multimillionaire director of Huntswood, a WhatsApp message requesting funding for the refurb in November 2020 … But in May this year, Lord Geidt, the independent adviser on ministers' interests, was told by the PM he did not know who was behind the nearly £53,000 flat refurb donation until February 2021".
Times political journalist George Grylls then revealed that he had used FOI legislation to request the WhatsApp messages in relation to this episode, and the Cabinet Office had claimed that none existed.
“Shamefully frivolous, vengeful and partisan”
PM Boris Johnson evidently doesn't know the first rule of holes: when you're in one, stop digging. Otherwise he – sorry, his friends – wouldn't have briefed this comical piece to the Mail about the BBC’s news coverage of the various scandals as “shamefully frivolous, vengeful and partisan”.
We really are living through a time of government by irony. The phrase is a pretty good description of the PM himself, as it goes.
The price
This feels like a consequential political moment. While Mr Johnson’s past ability to defy political gravity is impressive, there is something substantial in the British psyche about fairness. (It is a part of the reason for the public’s general and longstanding support for the NHS, even during times when its performance was objectively bad.)
These revelations offend against that.
Late, but at last, Labour have found a coherent attack line on Mr Johnson’s administration: that they are hypocrites on the rules; and that they are laughing at voters. Both messages are politically potent, especially to a frightened population seeing a resurgence of the pandemic.
If Labour can observe message discipline, they can broaden this into an attack on the open goal of incompetence.
Moonshot: Take Two
The PM rounded off his week by the Sunday evening announcement of an acceleration of the vaccination booster campaign – an Omicron emergency booster National Mission.
‘National Mission’. Riiiiight.
I am so deeply bored of the linguistic inflation here. It takes an onanist of an unfathomable magnitude to think that using a phrase like 'National Mission' means you are VERY SERIOUS ABOUT THIS.
Such rhetoric reveals only the speaker's faith that the very act of saying a thing makes it so. It’s a clear sign that the speaker is as big a liar as they are a narcissist.
This administration’s National Missions always work particularly well: who among us has forgotten the “world-beating” Test And Trace, or the 100,000 tests for a day episodes?
It’ll be a million vaccinations a day (Saturday was an unusually busy day, with half a million jabbed). Lots of wildly ambitious new vaccination targets for a knackered workforce to achieve. And, of course, the Army. They could probably start vaccinating cats or dogs, if the numbers drop. I mean, they cheated big-time on the 100,000 tests.
It could, however, have been worse. Yesterday, I hear from multiple sources that the PM’s ambition was to have an extra 38 million vaccinations completed by Christmas Eve, which would have meant doing three million vaccinations every single day.
The creaking system
The latest waiting list data showed, to the considerable surprise of absolutely nobody who’s paying attention, that the NHS backlog has just about hit six million. As ever, Dr Rob Findlay of Insource’s analysis for HSJ is an vital read.
NHS Providers boss Chris Hopson’s informative Twitter thread gives a useful view across then piece for the provider sectors of the NHS. He notes that “elective surgery waiting list has increased to 6 million (up 2.4% compared to last month). And the number of patients waiting more than 12 hours in A&E worryingly up to over 10,500 (the highest ever monthly figure and up 50% vs last month) … Bed occupancy at 94%, vs. last year’s 87%. Adult critical care occupancy likewise 81% vs 74%. Ambulance handover delays longer: %age of 30-minute-plus waits risen from 11% last year to 20% this year”.
Hopson concludes, “we should stop comparing Jan 2021 with Dec 2021. All the evidence suggests that NHS is under unprecedented pressure for this time of year”.
Meanwhile, the Sunday Times’ Shaun Lintern has a story about NHS staff intending to refuse to work on Covid19 wards in the next wave.
And The Observer looks across the piece in social care, thanks to the Homecare Association. Tl,dr – things are Really Not Good At All in the system, and Omicron demand is now about to hit over the next fortnight.
How bad will the impact of Omicron be? We’re still in the realm of guessing, because it has yet to hit a highly vaccinated and fairly-well boosted big population such as ours. This said, actuary Stuart McDonald cites LSHTM analysis that has some scary numbers drawn from the data to date: they discuss ranges from 21-35 million infections; 175,000-492,000 hospitalisations; 25,000-75,000 deaths. Even at the lowest end of these, the brown stuff is going to hit the rotating object in a big way.
Should vaccines remain largely effective, the increased transmissibility of Omicron means that even a small percentage of a big number who get hospitalisably sick will still be a big number, hitting a very full and very fragile system.
Privates on parade
Meanwhile, this week saw a very curious story briefed to The Times about private sector providers ready to come to the rescue, with the NHS about to ink new contracts. Is it a reference to the NHS Increasing Capacity Framework from October 2020?
The problem here is that there have been past reports of spare capacity in the independent sector during winter crises past, and the capacity has not in fact existed once it was sought. I understand that the private sector is dealing with its own waiting lists at present.
Cronyvirus and Coronamillions update
I haven't spotted anything very notable this week, but I did want to highlight the spot by procurement expert Rob Knott that the UK Health Security Agency let two big new contracts to Deloitte for functions that absolutely should be owned in-house if the UKHSA were any kind of serious organisation.
The FT covers this too, as well as new contracts let to Accenture, which the paper says has been asked to work on digital systems to “track and monitor compliance against international travel regulations associated with arrivals from red, amber and green countries”. Once again, this should surely be done in-house, as part of increasing our national resilience and preparedness for this and otbher pandemics.
This is frankly worrying. As Sky News’ Ed Conway noted in October 2020, Deloitte were supplying 1,114 staff to Test And Trace: a number that was the equivalent of a small Government department.
If the leadership of UKHSA have learned nothing from TAT, we should be very concerned.
Getting the Bill (Health and Social Care)
The Health Bill moved into the Lords on Tuesday. There were some notable speeches: the moist awaited was that of Lord Stevens of Birmingham, the artist formerly known as Simon Stevens.
However, it is also worth noting the contributions of Lord Lansley (whose 2012 Act is being almost totally eviscerated and euthanised by this Bill) and everybody’s favourite noble Baroness Dido Harding of Winscombe. Yes, really. The Hansard of the debate is here.
While much of the debate was courteous and considered, some was cobblers. There was a smattering of privatisation idiocy, from people who should really know better – ahem, Baroness Bakewell.
We also got some downright odd stuff: “the pandemic showed us that the current system is living beyond its means”, asserted Lord Bethell at one point in the debate. Reality, eh? Over-rated. (Anyway, Green peer Jenny Jones did earlier say “we need to do drugs differently”.)
From the number of speeches that raised the absence of workforce planning and excess of Secretarial (Of State) power-grabbing, I would say that Lord Stevens of Birmingham has been doing some characteristically effective lobbying of the ladies and lords spiritual and temporal.
The political question that follows is about the Government’s commitment to this brace of bad ideas. The Omicron wave means that Mr Javid is about to experience feeling very responsible indeed for the NHS: he may well find it uncomfortable. This could drive towards willingness to move on the ‘taking back control’/”more Matt Hancock” axis.
Once a Munchkin …
The other axis, workforce planning and training, is de facto the purview of the Treasury, who are set to stick firm with their penny-wise, pound-foolish short-termism over workforce planning.
‘If we don't build them, we won't have to pay them’ is perhaps the most stupid slogan imaginable, but it rings proudly around the Health team in Horseguards Parade. Once a Munchkin, always a Munchkin, I guess.
You could see their long-term mindset’s absence in their submission to the Pay Review Body, which the Telegraph spotted: a decent pay award would risk fuelling inflation and undermining the Government’s plans to hire more public sector workers.
Meaningful rises would, the Munchkins contend, “exacerbate temporary inflationary pressure, for instance through spilling over into higher wage demands across the economy or contributing to higher inflation expectations”. This might increase “cost of living pressures, as higher pay awards were offset by higher inflation”.
What a relief that longstanding workforce shortages due to zero planning, poor retention and inadequate training numbers don't give any rise to highly inflationary use of agency staff, eh?
The Government’s current political crisis will have to deepen considerably before fiscally anhydrous aspirant Rishi Sunak given the Munchkin mindset on health spending a wobble.
NHS England
There is no secret that relations between NHS England and Downing Street remain far from harmonious. As well as a blame-shifting dialectic regarding the ponderous rare of the booster programme roll-out (one in which the Joint Committee on Vaccination and Immunisation’s role has been strangely silent), there is ongoing and major disagreement about the NHS recovery programme.
This isn't surprising. The CSR funding settlement for the NHS fell below what all major bodies have agreed was the sum necessary to regain proper performance levels. 11 Downing Street is not giving ground on this; neither is NHS pope Amanda Pritchard. Her steel is showing: good.
NHS England itself is going through a period of internal turmoil. There is the in-housing of Health Education England, NHS Digital and NHS Kiss; and there is now the renewed emphasis on booster roll-out with then returned Emily Lawson in full flight. It was interesting that neither of the two short-listed COO candidates were appointed (one obvious and the other very much not so), and so Sir David Sloman has been brought in on an interim basis (as HSJ revealed), which will be interesting as regards London, where he is in charge for NHS England.
NHSE’s director of finance Julian Kelly gave a significant speech to the HFMA conference this week, reported in HSJ, in which he emphasised that payment by results (which is payment for activity, really) is to make a “strong” return to help drive elective activity. The emergency ‘block’ funding contracts brought in during the pandemic are to be removed.
Kelly also called for short-term measures to free up thousands of beds for the Omicron wave that will hit imminently. HSJ reports him as saying that NHS England will issue a one-year revenue allocation in the planning guidance (expected later this month), rather than the full three-year budget. He likewise acknowledged that increasing elective activity will require some capital investment to increase capacity: NHSE will issue a three-year capital allocation to each ICS.
Kelly told trust and system leaders to start thinking about how they could use the capital “to create better separation and protection of our emergency and our elective pathways”, as well as increasing diagnostic capacity.
Other important things
Would appear here.
Recommended and required reading
The latest ONS data on economic growth shows that “human health and social work activities grew by 2.6% in October 2021 and was the main contributor to October’s growth in services. Human health activities reached a record high level in October 2021, increasing by 3.5%, with growth from a continued rise in face-to-face appointments at GP surgeries in England. The NHS Test and Trace and vaccine programmes had a positive 0.1 percentage point impact on October’s gross domestic product (GDP) growth”.
Really interesting LSE blog about the corporatization of the NHS in England.
The latest SAGE update is here.
Covering the Elizabeth Holmes trial in relation to Theranos, The Economist proposes that this is a Silicon Valley/tech ‘fake it till you make it’ thing, as opposed to fraud. Mmmmmm. If not bullshit.
Interesting coverage in the Mail of a new diagnostic test that could identify antibiotic-resistant ‘superbugs’ within 30 minutes.