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Cowper's Cut 206: Living with leadership ambitions (oh, and Covid19)

Cowper's Cut 206: Living with leadership ambitions (oh, and Covid19)

The Government's heavily-trailed 'living with Covid' announcements last Monday were jeopardised by a last-minute row between Chancellor Rishi 'The Brand' Sunak and Health But Social Care Secretary Sajid 'The Saj' Javid.

This row, which caused Monday morning's Cabinet meeting to be rescheduled to the afternoon, was about money. Times Whitehall editor Chris Smyth reported that the disagreement is about £2 billion worth of testing budget. BBC News' Laura Kuenssberg came to a similar number.

Well, it's ostensibly about money.

Actually, it's about both men's belief that they would be an excellent replacement for Prime Ministerial placeholder Boris Johnson. So, off we go with another episode of The Great British Political Weakness-Off. Lèse-majesté, innit.

Nothing says 'future leader of the Conservative And Unionist Party' like a very public stand-off over money. Ex-Chancellor-on-Chancellor action of this kind is ... niche. It's all a bit "let's see how far we can go without getting sacked", isn't it?

This is Not Normal At All, as prominent lawyer and writer David Allan Green explained: "The ongoing informal (and sometimes even formal) exchanges between the Exchequer and the health department seem to have failed. The system of cabinet committees and sub-committees seem to have failed. And prime ministerial authority also seems to have failed – indeed the Prime Minister seems to have been unaware of the difference."

The Telegraph rushed out its briefing of a 'big Rishi win' on the same day: it is a camp classic. Team The Saj will get their retaliation into The Times, doubtless very soon. They got out a bad little promotional clip on the day, which is notable mainly for The Saj not really knowing how to look at the camera properly.

The other shadow over Monday's delayed announcement was an actual majesty: the Queen's infection with Covid19.

The PM announces 'Living With Covid'
The PM announced the much-trailed end of Covid19 precautions and mitigations to the Commons. Thank goodness that the hell of free Covid19 tests and mandatory self-isolation when infected will both soon be things of the past.

From the aptly-chosen date of 1 April, lateral flow tests will become free market commodities, as trailed. The free market worked absolutely brilliantly for overseas travel testing. It surely gives us all huge faith in this move.

The PM claimed that "we should be proud that the UK has established the biggest testing programme per person of any large country in the world".

No. We should be proud of the bits of TAT that worked, but given its cost and declared "world-beating" intentions, it was rightly judged a costly failure.

"It is time we got our confidence back" was a genuinely pathetic line from the PM. It's time we got competence back, but this Government wouldn't recognise competence if it bit them on the Big Dog.

Responding to Labour leader Keir Starmer's statement, the PM's points about Labour "week after week, month after month, I have listened to the Labour party complaining about NHS test and trace, denouncing the cost" was an absurdity. Test And Trace was a costly failure at its own declared aims, as the Public Accounts Committee report made amply clear.

Known unknowns
The statement overall was surreally absurd, as The Times' Chris Smyth pointed out: "remarkably little detail in living with Covid plan. Unresolved points include age at which you will get free tests after April; what advice on isolation will be after March; size of stockpile of LFTs / PCR capacity; scale of ongoing NHS and social care testing".

It's equally worth reading this Twitter thread by Imperial College Health Partners boss Axel Heitmueller, formerly of Test And Trace, on the implications of the announcements for a wider Covid19 strategy.

In an excruciating Downing Street Briefing that evening, the PM's boosterism stood in marked contrast to the words of the chief scientific advisor and chief medical officer.

Patrick Vallance said "This virus feeds off inequality and drives inequality ... I'd like the rate of infections to be lower"; Chris Whitty added that "the Omicron wave is still high, still between 1 in 20 and 1 in 25, according to the ONS survey ... this is still a very common infection .... we all expect there to be new variants".

The PM suggested that the UK should be more like Germany, where workers don't have a "habit of going into work when not well". Mmmmmmm. It's worth noting that statutory sick pay in Germany is 50% pay for 84 weeks; in the UK, it is £96.35 per week for 28 weeks.

Mr Johnson also announced that who is eligible for free testing from 1 April will be decided "in March". Yes, I'm reassured too.

Testng for NHS staff and vulnerable groups no longer led by public health advice
The Government's economic and political drivers for this strategy were made clear in Guardian deputy political editor Rowena Mason's account of a video briefing "by a senior member of the Covid taskforce delivered to civil service leaders across Whitehall on Thursday afternoon, making clear that following public health advice was no longer the sole priority.

"The senior official said public health advice would not be met in NHS or social care settings in relation to the testing of staff, and that was a “decision that the PM, chancellor and indeed the cabinet have agreed to”.

"He said: “It will be the case from 1 April that testing in DH own settings including the NHS and adult social care will not fully match the public health advice because of spending considerations. We will not be testing adult social care staff or NHS staff at the frequency recommended by clinicians because there is not the funding to pay for it”."

It was further reported that "there would not be additional funding from DHSC) or the UKHSA to cover testing in vulnerable settings overseen by their departments where there was a risk of outbreaks. This could include settings such as prisons, schools, children’s homes, detention centres, accommodation for asylum seekers and homeless shelters."

The price of LFTs
I'm intrigued by the suggestion that a box of seven LFTs will retail here for around £20, or £2.85 each.

Wholesale, a pack of seven costs £1.85 bought in bulk in the UK.  In a major French supermarket chain, a pack of five LFTs costs ¢6.2 - the equivalent of about £5.20, or just over £1 per test.

That's quite a disparity. Given the disgraceful price gouging we say on travel testing, and the incompetence of delivery, this should be a concern.

Last August, a large number of travel test providers were warned by the Government over misleading prices. The Competition and Markets Authority is investingating a number of those providers.

I'm becoming very curious as to what the Department For Health But Social Care is paying for a pack of LFTs.

It's also worth noting that while DHBSC recently set up a procurment framework for LFTs, they  then completely ignored it by awarding a £62 million LFT supply contract via direct award to MedCo Solutions (the Plymouth Bretheren-linked newly-incorporated company also awarded £84 million worth of PPE contracts).

Likewise, Innova just picked up another LFT supply contract worth £143.7 million.

Target practice
I'm old enough to remember when The Saj promised a review of "nonsense" NHS targets last September. So it was gorgeous to see that he announced new targets in his speech to the HSJ event this week.

As Kings Fund policy boss Sally Warren noted, "that’s 15 days between the Integration White Paper committing to a reduction in the number of national targets, and new national targets being announced".

I think it's clear what's happened here: The Saj and the IWP were actually meaning to say that there will be fewer Bad National Targets - but these are Good National Targets ... and digital, too.

Our consistency czar wants 90 per cent of all trusts on to electronic patient records by the end of 2023; and 75 per cent of all adults in England to have downloaded the NHS app by March 2024.

Having downloaded the NHS app is an obvious nonsense target. Having some actual, attractive and demonstrable use for it would be.

So, about that workforce plan ...
The absence of a workforce plan was again highlighted by Health Select Committee chair Jeremy Hunt in his question to the PM.

I have been pointing out for at least a year that the no-longer-that-newly-announced community diagnostic centres will need staff and people to read the resulting tests/scans: this has now been picked up in a fairly decent Denis Campbell piece in The Guardian.

It covers Minister Argar's written answer to a PQ, which reveals that the centres will need an extra 3,500 radiographers to carry out diagnostics tests and 2,000 radiologists to interpret the results; as well as 500 advanced practitioners, who are senior nurses.

So the system is another 6,000 staff short. Add them to the vacancies pile.

And this pile is being exacerbated by about 400 NHS staff quitting every week for work-life balance/burnout reasons, according to new research by former DHBSC strategy director John Hall for Engage Britain and shared with The Observer.

Oh, and on pay ...
The DHBSC's submission to the Pay Review Body was spotted by HSJ, who report that they favour holding down pay to catch up on the backlog and on 'lost' efficiency fromt he pandemic.

In a clearly Treasury Munchkin-inspired move, DHBSC's submission argues “NHS financial sustainability is key to its post-pandemic recovery with increasing productivity crucial to restoring the performance of the NHS … There is an expectation that the NHS can catch up on some of the lost efficiency and make productivity savings in 2022 to 2023 in order to return to financial balance ...

“Any pay recommendation needs to be absorbed within existing budgets. To put this into context, each additional 1 per cent of pay for the workforce costs around £6m per year allowing for the full system costs. This equates to around 100 full-time nurses or 3,500 procedures. For the [hospital and community health service] workforce as a whole, an additional 1 per cent of pay costs around £900m which is equivalent to around 16,000 full-time nurses or 500,000 procedures.”

In a gorgeous piece of symmetry here, 16,000 nurses maps near-perfectly onto the 18,500 sub-figure used within the Government's Manifesto-promised 50,000 more nurses to describe those who would have quit, but will now decide to stay. The irony is mordant.

The Alan comeback
The People's Partridge talked about "trusting to personal responsibility" to the Commons and in the media. Yes, that's this very same person.

Commons Speaker Lindsay Hoyle this week called Alan for his question as "the man for the rules, Matt Hancock". A-ha!

Coronavirus and cronymillions update
You don't think you can keep being surprised by this stuff, but I was when Civil Service World revealed the UK Health Security Agency's £1 million contract with Deloitte for hepling UKHSA to get private lateral flow tests onto the market, after the surge in demand for Covid19 tests this winter.

CSW reports that the deal's aim was "to be the quickest and most efficient way for the agency to assess private providers so they could sell tests ... Deloitte is not involved in evaluating tests directly, but is assessing providers against standards produced by the government".

I'm sorry: WTF? This suggests an almost complete loss of organisational continuity and memory from Test And Trace, which was subsumed into UKHSA. Test And Trace had many flaws, but its checking of testing providers' products was both effective and timely.

In a not-insane world, Test And Trace's expertise would have been catalogued, creating a legacy strategy and viable cost-benefit options models that could give sceintific guidance on when to turn testing off, on or up.

Indeed, those things actually existed. It's just that Mr Sunak chose not to make the funding available for them. UKHSA got shafted by budget cuts in the last Spending Review, and Ian Peters' threat to resign as chair.

Unreliable tests
CSW's Beckie Smith came up with another cracking revelation: that the current validation scheme for private tests fails to ensure tests are sufficiently reliable, or to enable people to make informed choices about which tests to buy.

Smith has been birefed by experts that lateral flow and PCR tests being sold for general use in the UK do not have to meet the same rigorous standards as tests bought by the DHBSC to be distributed through GOV.UK and pharmacies.

Recommended and required reading
The NHS Confederation, suported by Palantir, has published Governing the health and care system in England: creating the conditions for success, a big new report by Professor Chris Ham

Insightful Guardian Long Read from Clare Gerada about what has changed in her working lifetime as a GP.

Interesting Times piece about the possibility of developing personalised treatments for autoimmune diseases.

Sobering FT piece by former Lib Dem political advisor Miranda Green on getting cancer during Covid19.

In a particularly shameful bit of media management, on the day war broke out in Ukraine, the Government slipped out its admission that veterans involved in UK nuclear tests were not in fact at a similar risk of cancer and early death (as claimed for decades), but a far higher one. Susie Boniface of the Mirror spotted it.

Chancellor Rishi 'The Brand' Sunak's Mais Lecture text is here.