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Cowper's Cut 200: Elect a clown, get a circus

Cowper's Cut 200: Elect a clown, get a circus

We’ll get on to this week’s pitiful political pantomime directly, but let’s treat ourselves to starting ‘Cowper’s Cut’ Number 200 with a small amount of good news.

Friday’s data update saw see this year's first (small) decline in the seven-day hospitalisation rate (the seven-day rate fell by 1.4%). And that is good news.

Of course, let’s remember that there are still almost as many people in hospital with Covid19 now as there were during the first wave.

The latest SAGE minutes offer realism about what’s walking in currently. Likewise, about what is forthcoming. It warns in particular that “the spread of infections in older age groups, which are lagging younger cohorts, will be a determinant of the number of hospital admissions”.

Just as pertinently, SAGE state that “a shorter serial interval does not necessarily mean that people with Omicron stop being infectious sooner than those with Delta”. This is interesting, given the timing of the Government’s announcement this week that following new UK Health Security Agency data,  self-isolation can be shortened to five days if testing negative with lateral flow tests.

SAGE are also clear that “it remains likely based on the scenarios that hospital admissions in England will remain high for some time as a result of the very high number of infections and the continued risk of hospitalisation for the elderly and unvaccinated adults in particular.

“Early data from CO-CIN indicates that the severity of disease being observed in hospital over the last three weeks is lower than observed in early phases of previous waves, with less need for oxygen, less admission to intensive care, better outcomes, and shorter stays. A shorter average length of stay means a reduced average hospital occupancy for a given number of admissions. Unlike in previous waves, intensive care units are not likely to be the part of the health system under most pressure in this wave (medium confidence). The probability of needing admission to ICU is very much higher in the unvaccinated population and outcomes remain poor for those who require mechanical ventilation”.

The very human impulse to declare ‘phew, we’ve peaked’, followed by widespread relaxing instantly, could well mean that we haven't peaked. And the knock-on effect of the return of schools may not be fully here yet. As ever, it’s worth reading intensive care doctor Rupert Pearse’s balanced thread.

Fight For Your Right To Party
This week saw the revelation of multiple accounts of partying in Government during the periods of lockdown restrictions.

ITV News obtained emails showing that in May 2020, at the time permitted meetings were limited to two people outdoors, 100 Downing Street staff were emailed and invited to a ‘bring your own booze’ party.

This email was sent by the Prime Minister's Principal Private Secretary Martin Reynolds to over a hundred employees in Number 10, including the Prime Minister's advisors, speechwriters and door staff.

PMQs and the non-apology apology
That made Prime Minster's Questions event television this week, even beyond the political nerd community.

How would he play it?

Would the PM come clean? Or was Johnson gonna Johnson?

“Mr Speaker, I want to apologise”, said PM Boris Johnson.

He then didn't, obviously and repeatedly. It was a classic non-apology apology.

“A work event … technically within the guidance”
The PM’s defence had evidently been legalled to within an inch of its life: “when I went into that garden just after 6 o’clock on 20 May 2020, to thank groups of staff before going back into my office 25 minutes later to continue working, I believed implicitly that this was a work event, but with hindsight, I should have sent everyone back inside …

“I should have recognised that even if it could be said technically to fall within the guidance, there would be millions and millions of people who simply would not see it that way”.

Others are to blame
The PM’s wording was also telling during Labour leader Sir Keir Starmer’s questioning: the PM said “I have and will continue to apologise for what we did”. Note the use of ‘we’: Mr Johnson is looking for others to blame.

The PM was evidently advised by his lawyers to reach for a defence based on his belief about the BYOB party – sorry – work event: “I accept that we should have done things differently on that evening. As I have said to the House, I believe that the events in question were within the guidance and were within the rules … my apology for all the misjudgments that may have been made—that were made—on my watch in No. 10 and across the Government”.

This is a theological defence.

Mr Johnson hopes that someone, somewhere will buy the concept that his belief that a ‘bring your own bottle’ party is a work event may have protected characteristics.

According to the reliable Paul Waugh of the i, the PM then toured the Commons Tea Room telling Conservative MPs that the “bring your own booze” party “was not his fault (he wasn’t sent the invite) and he was “taking the blame for others” (i.e. civil servants and special advisers)”.

The Metropolitan Police are continuing their streak of strong understanding of what their job is, with their announcement that they will not investigate the breaking of the law by the Downing Street parties (all evidently within earshot and probably sight of Met officers working on security there) unless the Sue Grey inquiry deems it is a crime.

The flag-worshipping party disrespects the Royal Family
Probably the most damaging was Friday’s subsequent revelation of two separate parties in Downing Street the night before the burial of the Duke of Edinburgh, which forced 10 Downing Street to apologise to the Queen.

That was revealed by the PM’s fanzine and “boss”, the Telegraph, which also got the scoop that Kate Josephs, the former head of Covid rules for the Government, held a boozy leaving party in Whitehall during lockdown.

Not to be left out, Tortoise revealed that the PM and has wife appear to have repeatedly violated travel regulations to move between Downing Street and Chequers during lockdown.

One of the excuses made for the Partygate events is how hard people were working: it’s well worth a read of this FTpiece interviewing NHS staff who were genuinely hard at it (and risking their lives) through the pandemic.

The lying culture
As Jennifer Williams of the Manchester Evening News neatly observed, the Johnson administration’s corrupt, inept and tardy conduct of most of the pandemic makes much more sense now we know that they spent the period getting shitfaced pretty much non-stop.

Conservative Party chair Oliver Dowden (who reiterated the rules on the televised Downing Street briefing just nine minutes before the start of the infamous Downing Street ‘BYOB’ garden party) attempted to tell BBC1’s Sophie Raworth on the Sunday Morning show that the “underlying culture” in Downing Street had fed into Partygate.

What utter crap. The problem with the Johnson administration is the lying culture, not the underlying culture.

The PM’s allegation that he didn't know about or see the invitation to the ‘BYOB’ Downing Street Garden Party was undermined in Dominic Lawson’s Sunday Times column, which cites “a former Downing Street official who said at least two people had told the PM, after seeing the emailed invitation from his principal private secretary, Martin Reynolds, that this was “a party” and should be immediately cancelled. I was told that Johnson’s dismissive response was to say they were “over-reacting” and to praise Reynolds as “my loyal Labrador”.”


There’s only one Big Dog, and it’s not the PM
The PM’s self-preservation plan – Operation Save Big Dog, according to The Independent – apparently involves laying down the careers of junior Downing Street staff and civil servants for Mr Johnson’s political life.

Greater love hath no woman or man: I’m sure they’ll all be bang up for that. What could possibly go wrong?

You elect a clown, you get a circus.

And watching a party of Government negotiating this novel mash-up between Stockholm Syndrome and a circular firing squad is certainly a bracing way to do national politics.

Privates on parade: in extremis and not overwhelmed
There was interestingly little coverage of this week’s decision by NHS England Pope Amanda Pritchard to request ministerial direction from Health But Social Care Secretary Sajid ‘The Saj’ Javid’s mandating of the NHS to buy capacity from the private sector on what looks very much like the old ISTC ‘take or pay’ model.

The NHSE letter is here.

The Saj emphasises that this must only be done “in extremis”, which is ever so reassuring and clear as definitions go. It’s about as helpful as “unsustainable”.

Ms Pritchard is being smart. To the best of my awareness, no previous NHS Commisisoinng Board/England CE has requested ministerial direction.

There are a few problems with this strategy. The main one of them is the lack of clarity that this capacity actually exists in the private sector.

Anecdotal evidence tells me this putative capacity does not, in fact, exist. Similarly, it is suggested to me that NHS doctors who formerly did a little private work at evenings and weekends to practice lower-intensity medicine with ‘nicer’ patients in pleasant settings with proper admin support have begun to stop doing so. A common cause for this change is that the NHS meltdown has pushed far sicker people into the private system, and the work is now stressful and high-stakes. Another is that private sector rates for insured work have not risen as these people would expect.

Waiting times worsen – again
The latest NHS England data shows a further deterioration of waiting times, with the figure moving over 6 million. The Omicron wave will of course make this figure grow. It’s also worth re-reading the Institute for Fiscal Studies’ December 2021 ‘where are all the missing hospital patients?’ report.

Health Service Journal’s James Illman and Matt Discombe analyse the data, and note that the top-line increase of two-year waiters by 15% is of major importance.

This comes on top of another leak to HSJ revealing that “the number of patients who waited 12 hours or more in an emergency department, from decision to admit to being given a ward bed, increased by around 15 per cent in December, compared to the previous month”.

In a stunningly foolish move, HSJ spotted NHSE guidance that people who refuse to vacate NHS beds for offered short-term step-down care should be threatened with legal action.


This is likely to age about as well as the infamous NHSE ‘immediately stop all ambulance handover delays’ guidance. Ironically, NHSE press-released their latest ambulance data with the headline ‘Record number of NHS ambulance call outs for life-threatening conditions in December, despite jump in Omicron absences’.

Because when a system is under enormous and sustained pressure, more shouting at people to do the obvious always helps.

Perhaps folk at NHSE should take a look at the ADASS winter contingencies survey results.

Numbers and predictions
With the debate about Covid19 death numbers reignited by the discreperancy between the official figure passing 150,000 this week and the ONS number being 175,000, and fresh revelations about huge deterioration in A&E waiting times, It’ll be interesting to see how well Monday’s Times story about most of the NHS avoiding crisis, citing NHS Providers CE Christ Hopson, ages.

The small matter of a workforce crisis
The ongoing workforce crisis gets due attention in this Nuffield Trust chart of the week on sickness absence rates, and this Guardian piece covering workforce pressures.

Meanwhile, HSJ reports that as we head towards the deadline for unvaccinated staff to be moved or removed, guidance from NHS England is telling trusts “to prepare for redeploying or dismissing thousands of unvaccinated staff without an exit payment, and to raise the alarm about services which may be rendered unsafe”. The guidance is here.

The exact number of unvaccinated staff in question is unclear, but speculation puts the number between six thousand and eight thousand. The Nuffield Trust’s Billy Palmer has a good update.

Labour opportunism: it’s alive!
It’s been quite a while since I saw Labour do some successful opportunism, but they managed to capitalise on their post-PMQs momentum this week with this short Keir Starmer Comment piece in The Guardian, showing some leg on their ideas about health.

It’s not tremendously detailed, inevitably. But it is a start on seizing the policy agenda as the Conservatives are in a chaos that won't go away any time soon: this felt brought forward. Hopefully, it was. People need to start getting some good reasons they might vote for Labour, rather than against a PM who will probably be gone quite soon.

Starmer gave a speech to the Fabians’ conference, which addressed the broad outline of Labour’s health policy: “one, to tackle the immediate crisis. To bring down waiting times by recruiting, training and retaining the staff we need.

“Two, to make mental health as important as physical health.

“And three, to shift the focus of health care to prevention as well as cure”.

They’ve even managed to get it down to a decent summary in three clear points to round it off. Labour may just be starting to learn.

A shot across the bows
Most of what is on Twitter is ephemeral and inconsequential.

This one might not be, however: KPMG head of health Dr Mark Britnell tweeted a photo of himself with ex-Dr Foster boss Tim Kelsey, and the promise-cum-threat that “we’re doing some global work looking at the “retreat of quality” and the transparency - or otherwise - of governments and health authorities around the world to publish data on patient safety and quality during the pandemic”.

One to watch.

The Alan comeback
He’s got Covid again. No supportive tweets about the PM this week, though, so maybe Omicron improves your sense of taste?

Cronyvirus and coronamillions update
Last week, I picked up on a curious Telegraph piece citing BIVDA-led complaints about how the Government had treated British diagnostic test manufacturers. It was all the Good Law Project’s fault, apparently.

With poetic symmetry, Government pandemic advisor and Oxford University Regius Professor of Medicine Sir John Bell used the Telegraph on Monday to air his views  that British diagnostic test manufacturers should shut up complaining and produce tests that manifestly work. The article reports that “Sir John said supplies were “now looking good”, attributing much of the disruption to the public ordering a surplus of tests in the run-up to Christmas, to ensure they could continue seeing friends and family”.

Mmmmmm. This article also asserts that “the reason tests went out of stock, according to Tory MP Sir Roger Gale at the time, was that the UK was “competing in a global market”.”

Ahem. This very much contradicts the account cited last week ago from data expert Ankur Banerjee, who explained the causes of UK’s parlous testing availability situation in this enlightening Twitter thread.

Mr Banerjee says that the key issue is that “all of the distribution is being handled by a single company which will be closed for 7-8+ days around Christmas and New Years' Eve, and therefore shortages will persist … overall, there's only approx. 1.25mn Covid LFD test packs that will even be processed at the distributor. (There are ~27.8mn households in the UK.)

”Given that the Govt/NHS should have known back in the beginning of December that their distributor was planning to close down for a significant portion of the holidays when there would be high demand, it's pretty shambolic that they didn't have backup distribution plans in place”.

This points the finger firmly at the role of a monopoly distributor of tests. Again, this Telegraph piece looks like one to bookmark.

Meanwhile, the Good Law Project won a significant victory with this week’s High Court judgment that the Government’s VIP fast-lane for Covid19 contracts was illegal. You can read more about it here and here.

Astonishingly, the Government is now in dispute with one supplier pushed their way by Conservative peer Baroness Mone.

Getting the Bill
"The NHS has got into the habit of ignoring the legal niceties in recent years to get round the problems created by the 2012 legislation, and I am not sure whether it should be congratulated on that or not."
Baroness Glenys Thornton, Health Bill committee, House of Lords January 2022

“As I pointed out when the Five-Year Forward View was released, Simon Stevens has an elegant solution to all these many legislative inhibitions and confusions. He simply ignores the shit out of them; acts as if they were not there; and dares anyone to do anything about it”.
Health Policy Insight, August 2015

The Lords debates this week (Hansard texts here and here) simply saw the bulk of the proposed amendments withdrawn after solid consideration. Not very unusual, for the Lords. The sessions this coming week might be more consequential.

Other important things
Would appear here.

Recommended and required reading
Proper one of these next time, probably. It’s been a bit of a week, news-wise.

Good Health Foundation report on our ageing population in England, and how it drives health and care need: as Centre for Policy Studies boss Robert Colvile noted this week, the latest ONS data shows that the number of people aged 85+ will almost double between 2020 and 2045 (and there will be 59,000 more deaths than births over the next 10 years).

National Audit Office boss Gareth Davies calling for the Government to be honest about whether their projects are worth the money – a punchy article in The Times.