There was one clear winner of the Conservative And Unionist Parliamentary Party's vote of no confidence in PM Boris Johnson last Monday: it was Labour leader Sir Keir Starmer.
Mr Johnson is clearly holed below the water-line by this result. He may not sink fast, but he will sink. Having over 40% of his MPs vote against him mid-Parliament is as dire as it is irrecoverable.
211 of his MPs supported the PM: 148 did not. Those 148 Tory MPs who voted no confidence in the PM's leadership represent 41 per cent of the MPs that Johnson led to a big electoral victory in December 2019.
Mr Johnson's vote of no confidence (VONC) is a proportionately bigger share of his MPs than those who voted against John Major in 1995, or against Theresa May in 2018. It matches the proportion who voted against Margaret Thatcher in Michael Heseltine’s 1990 leadership challenge.
Throughout the day of the VONC, senior and serious Conservative MPs came out against the PM. Jesse Norman's calmly devastating letter is worth reading in full, as is the letter/statement from the Government's anti-corruption tsar John Penrose that "I’m sorry to have to resign as the PM’s Anti-Corruption Tsar but, after his reply last week about the Ministerial Code, it’s pretty clear he has broken it. That’s a resigning matter for me, and it should be for the PM too".
It's worth noting that both of these men were ardent Brexit supporters, and that both backed Mr Johnson's leadership. (Mr Norman is married to vaccines procurement hero Dame Kate Bingham, and Mr Penrose to the The Noble Baroness (Dido) Harding of Winscombe, both of whom have direct and personal experience of the PM's unique brand of disloyal chaos.)
Health Select Committee chair Jeremy Hunt (runner-up to Mr Johnson in the last contest, and seen by betting markets as leading the odds to succeed this time, as a 'clean-skin') set out his change of mind why now had become the right time for a change of leader in this series of Tweets.
Mr Hunt was instantly and vitriolically attacked by Mr Johnson's joint-biggest fan: Culture Secretary and ex-Health Minister Nadine Dorries. The Times reported that this attack was authorised by Downing Street.
Specifically, this Blue-On-Blue firefight saw Ms Dorries - a Cabinet Minister, remember - claiming that the Government did not prepare properly for the pandemic. This is an allegation that the Covid19 public inquiry may wish to pursue (especially as Dorries was a health minister responsible for patient safety during the pandemic).
That attack is unlikely to cost Mr Hunt much sleep, although it marked a big change from La Dorries' view of Mr Hunt in 2012:
After the vote, Mr Johnson did this remarkable interview for the Lobby media.
The PM repeatedly sniffs loudly; looks glassy-eyed and sweaty; and energetically mumble-stumbles over his words. A cynical observer might wonder if Mr Johnson had taken his stated aim to "draw a line" under leadership speculation too literally: it is doubtless pure co-incidence that these are all symptoms of cocaine use.
I'm sure it's just a summer cold, or something.
In the aftermath of the VONC, the Telegraph (which the PM calls "my boss") published the above extraordinary speculation that Mr Johnson might offer Jeremy Hunt the Chancellorship. That seems very unlikely indeed.
It was interesting to see Labour leader Keir Starmer use all six of his PMQs to go on the NHS. His attack was accurate, but underpowered: as the shrewd Isabel Hardman observed in The Spectator, this may well have been deliberate. To have a wounded Johnson limping on pro tem is, as I have written, one of Labour's very best options. The Telegraph's interview/profile of Starmer is worth reading.
So, how was Health Week Two?
This was meant to be another 'Health Week' for the Government (following December 2021's triumph).
"A Blockbuster healthcare system in an age of Netflix"
The above takes (from the PM's Official Spokesman, and the Mail's political editor) reporting on Health But Social Care Secretary Sajid 'The Saj' Javid's Cabinet comments, make explicit what members of the Paying Attention Community have known for years: that this administration has no ideas about how to improve either health or (but) social care.
Their sole idea is to 'comms it'. Hence this meaning-free metaphor: really, it's more of a meta-against.
Their problem for then Johnson administration is that now their political mortality is explicit, they're starting to be asked proper questions. And they evidently don't have answers. Or even serious ideas. (I mean, at least the defunct video rental chain Blockbuster tended to be fully staffed ... and Netflix is losing subscribers and its share price is tanking.)
In its own way, it's magnificent: they've simply abandoned reality, wholesale.
What's also quite adorable is that now, we can make up our own Saj-isms about the NHS: 'a ventouse service in an age of chrome'; 'a metric service in an era of re-Imperialisation'; 'a stochastic service in an age of paisley'; 'a son et lumiere service in the age of ABBAtars'; 'a weltschmertz service in an age of schadenfruede'; 'a Spaghetti Western service in an age of Love Island'.
'A Blockflix service in an age of Netbuster' makes as much sense, frankly.
Messenger shoots straight, but gets played on the launch
The Messenger Review dropped, and contained most of what was briefed to Heath Service Journal back in April.
Its seven recommendations aren't wrong. Nor were they wrong on any of the previous occasions that people reviewing NHS leadership have found them.
The issue with The Messenger Review achieving anything is a distinct lack of 'how'. There is no theory of change. The Review's call for a Review Implementation Office (RIO) is smart, but it is highly unlikely to be enough.
The 2018 Kerr Review and the 2015 Rose Review both came to many of the same conclusions as this one does: nothing happened as a result. The Kings Fund pulled together this telling timeline of recent major NHS reviews, most of which have been similarly low-impact.
What is striking about the Messenger Review is that it's quite well-written. This is Not Usual in health policy documents, to put it mildly.
The Messenger Review is, albeit politely, damning about national and political leadership of the NHS. These lines from the executive summary stand out: "The sense of constant demands from above, including from politicians, creates an institutional instinct, particularly in the healthcare sector, to look upwards to furnish the needs of the hierarchy rather than downwards to the needs of the service-user.
"These pressures inevitably have an impact on behaviours in the workplace, and we have encountered too many reports to ignore of poor behavioural cultures and incidences of discrimination, bullying, blame cultures and responsibility avoidance.
"We experienced very little dissent on this characterisation; indeed, most have encouraged us to call it out for what it is.
"These symptoms are not, we would observe, necessarily the fault of historical or existing leadership teams or their staff. They are the result of a combination of factors over many years; some structural, some cultural, some emanating from behaviours at the top, including politicians, some born of complex inter-professional and status issues in the workplace.
"The important conclusion, however, is that they should not be tolerated as they directly affect care of the service-user as well as the staff, and that they can be tackled but only through determined cultural change from the top of the system to the front-line."
It's spot-on there. And it's instantly clear why the Department for Health But Social Care issued a press release on Tuesday afternoon which featured none of this. The national media just covered that press release, and The Saj's empty rhetoric, and did not go back to look at this.
General Gordon Messenger and Dame Linda Pollard have done a decent job here. The DHBSC couldn't have people paying attention to their actual conclusions, of course: they were pretty directly in the line of fire. So they didn't shoot the Messenger, but they sure as hell played him. Ironically, this makes the above-quoted point almost perfectly.
The Saj tried to retail the report to Parliament and the media as "a once in a generation shake-up of management, leadership and training". A generation? Perhaps The Saj meant a generation of gerbils.
The Saj also told Parliament that in his view, "there are too many diversity roles in the NHS". Perhaps he didn't read that morning's news reports of new RCN research showing that white NHS nurses are twice as likely to be promoted as their black and Asian colleagues. And perhaps he hasn't been following the Workforce Race Equality Standard data, which tracks problems facing minority ethnic staff. Perhaps it's just red meat for the Right of the Tory Party demographic.
As if this were not enough for one week, The Saj gave this interview to The Times in which he claimed “the NHS now has locked in the resources it needs. It doesn’t need any more money. What it needs to deliver for more people is not money: It needs reform.”
The Times piece quotes The Saj thus: “you want to have a system that, yes, it’s got the values of 1948 but looking at delivery towards 2048,” he argues, citing the need for better leadership, smarter use of data and rethinking GP services and more services provided via the NHS app. “It is absolutely possible to drive change and reform in the NHS — and we have to, it’s not a choice,” he insists. “The NHS this year, its budget is bigger than the GDP of Greece".
This is a fiesta of rhetoric, unattached to any actual policies. As stated above, the Messenger Review is light on the crucial 'how' of delivering leadership change. On changes to digital and GP services, you might imagine that a 'Health Week' would offer some details: there were none.
And is the GDP of Greece (c. $200 billion in 2017, with a population of about 10 million) any kind of meaningful comparator with a the budget of a health service offering universal coverage to the UK's 65-million-odd population?
Were The Saj wanting to be consistent, he could have compared the NHS budget to the market capitalisation of Netflix (currently about $80 billion). It means just as little as the comparison with the GDP of Greece. I can see that 'Sajid Javid's Fatuous Remark Of The Week' may have to take its place alongside 'The Alan comeback' as a 'Cut' regular feature.
If The Saj were wanting to do anything serious, he'd be looking at ways to bend the healthcare demand curve downwards, but his messages on the demand side are basically viva-Ayn-Rand, laissez-faire anti-public health ones: "people will decide rightly for themselves, whether they’re going to smoke and drink, they’re going to want to eat fatty foods, but people also will expect the state to warn them of the risks. People value information on healthy lifestyles — it’s about moderation".
The Saj really is an extraordinarily mediocre Parliamentarian and politician. He's just ... nothing. An empty raincoat, in Charles Handy's phrase.
Select Committee on workforce
The Commons Health But Social Care Select Committee's workforce hearing heard a careful performance from NHS Pope Amanda Pritchard. She kept thanking committee members for their questions. (If she's so keen on questions, she should do some interviews: they're full of them.)
Chair Jeremy Hunt asked The Saj when the Framework 15 workforce plans will be published? The Saj waffled gamely, but promised that it will be before Parliament's summer break. F15 will not give numbers, Javid cautioned: it will be about drivers; skills; behaviours; use of tech; how disease has changed.
That's fine. Who needs anything as basic as numbers?
Yet Mr Hunt persisted, and The Saj said that NHS England's workforce strategy would produce numbers by the end of the year.
He didn't specify which year, of course.
At one point, The Saj claimed that hospitalisations due to Covid19 were "dropping away, thankfully": a statement which is at variance with the latest data shown here by actuary John Roberts. As the week ended, Covid19 hospitalisations continued to rise. The latest ONS infection survey data also tracks increases.
Concluding the session, Mr Hunt asked The Saj to explain his "Blockbuster/Netflix" bollocks. The Saj claimed Cabinet confidentiality over what he actually said, but claimed that much of the NHS is still set up as it was in 1948. This is utter nonsense, of course.
What do the workforce themselves say?
Well, GP magazine Pulse reported its new survey's findings that 47% of GPs plan to retire before the age of 60. Of those who intended to retire at or before the age of 60, 12.5% planned to bow out before reaching 55. GPs suggested that this trend was driven by “intense workload and workforce pressures”.
The international recruitment situation has become ugly as regards recruitment: GMC data obtained by FOI shows that the NHS is for the first time hiring more doctors from outside the UK and EEA than from inside.
The Fictional Forty attract NAO attention
Rather overshadowed by the PM's VONC shenanigans, Labour's health lead Wes Streeting called for a National Audit Office review of the Government's plan for 40/48 fictional new hospitals.
It seems that the NAO is indeed preparing such a review: HSJ's Henry Anderson suggests that this was in progress prior to Mr Streeting's intervention.
What may prove a more powerful intervention is Lord Stevens of Birmingham's tabling of a written Lords Parliamentary Question, asking "Her Majesty's Government what is the (1) planned construction start date (2) expected construction completion date and (3) budgeted cost for each of the 40 new hospitals they propose to build by 2030".
Lord Kamal's eventual answer should be quite funny.
Rutherford goes to the wall
The Rutherford Health chain of private cancer centres filed for bankruptcy protection this week, as HSJ's Nick Carding spotted. Their medical director, 'The Positive Professor' Karol Sikora, will be an unhappy man.
Its subsidiary, Rutherford Diagnostics, opened an imaging centre in partnership with Somerset Foundation Trust: this is not thought to be at risk.
Rutherford (which provided offer chemotherapy, immunotherapy, radiotherapy and high-energy proton beam therapy as well as comprehensive diagnostics services) was beneficially owned by private equity: Schroder UK Public Private Trust.
It is suggested that their failure to win national NHS contracts was rooted in senior oncologists' surprise about their business model, which was seen as being the acquisition and inappropriate marketing of inferior specifications of proton beam radiotherapy for medical conditions that didn't need it.
It remains to be seen whether NHS England will deem Rutherford's assets worth acquiring in a fire sale. It probably depends on the price.
Labouring towards a health policy
They're clearly not there yet, but the emerging policy priorities appear to be broadly sensible.
The People's Partridge turned atypically Trappist this week on the topic of the leadership of PM Boris Johnson.
Where were the perky Hancockian Tweets of support that we, Alan's ardent admirers, have come to know and love?
Nowhere to be seen, that's where: either before or after the VONC.
Alan also appeared on ITV's Loose Women on Wednesday - he's definitely running. Oh, and he was shilling for crypto yet again, in well-suited company.
Cronyvirus and coronamillions update
£4 billion worth of unusable PPE, which is to be burnt, is pretty shocking. The Department for Health But Social Care lost 75% of the £12 billion it spent on PPE in the first year of the pandemic to inflated prices and kit that did not meet requirements.
24% of the PPE contracts awarded are now in dispute - including contracts for products that were not fit for purpose, and one contract for 3.5 billion gloves where there are allegations of modern slavery against the manufacturer.
Oh, and at long last, BBC News has started reporting on the PPE Medpro and Baroness Mone scandal.
Recommended and required reading
An investingation by BBC Panorama has found that Centene-owned Operose Health, the UK's biggest chain of GP practices, lets less qualified staff see patients without adequate supervision
Capita have been rewarded for a decade of incompetence in delivery of support services to primary care by a three-year extension to the contract, Pulse reveals.
Palantir's candidacy in the upcoming £360 million Federated Data Platform procurement is again in the media, with the Financial Times covering Phil Booth of MedConfidential's concerns. (COI declaration: I sit on Palantir's advisory board).
The FT also covers the UK's uniquely bad (among major economies) inflation problem, the impact of which on public spending power I surely don't need to explain. We are set to have the G7's highest inflation until 2024.
HSJ reports that NHS providers have been ordered by the centre to take tough new measures to reduce overspending. (Topical, you say? This is from 2015: I've quoted it merely to make the point that very little has changed these past seven years, apart from much longer waiting lists.)
A decent Times long read on improvements in cancer treatments
Excellent and worrying Health Foundation piece on the cuts to public health grants
“Although we didn’t do anything illegal in this process, we didn’t take into account the broader context of what was going on ... if we’re making mistakes, we will fix that. But we need to separate out ‘where are we making mistakes?’ from ‘where are we meeting the tough problems?’”: the new chief executive of Big Four consultancy firm McKinsey talks to the FT on the firm's involvement in the US opioid scandal, and where it goes next.
Wigan DPH Professor Kate Ardern is stepping down from her full-time role: the Manchester Evening News has a nice piece on her career