11 min read

Cowper’s Cut 234: Delivery, delivery, delivery

Cowper’s Cut 234: Delivery, delivery, delivery

In her victory speech for the Conservative And Unionist Party's summer 2022 leadership race, Liz 'Surgical' Truss promised her party that "I will deliver on the National Health Service".


At least her audience of Conservative MPs and members applauded this line promptly, in very much the way that they didn't applaud promptly when she praised her predecessor, Boris Johnson.

PM Truss's mantra thus far in her reign has been "delivery, delivery, delivery". It is unclear what Ms Truss plans to deliver on the NHS, though.

There was another line in her speech which I'd expect to hear a lot more often: "our great Conservative party: the greatest party on Earth". This has what I'm sure is an unintentional resonance with Harold Wilson's much-used line about the Labour Party: "this great movement of ours". The late, great political journalist Alan Watkins used to refer to this rhetorical trope of Wilson's by the acronym 'TIGMOO'.

If La Surgical tweaks her phrase slightly, we may easily end up with 'TIGPOO' - or perhaps more accurately, in it.

An awkward wooden thing

Later on the day of her victory, an awkward wooden thing appeared outside 10 D0wning Street. As well as Liz Truss, there was a modish new lectern.

The now-Prime Minister's four-minute speech listed the NHS as the third of her main three priorities (the others are the economy and energy).

She first promised that "I will make sure that we are building hospitals", so the Fictional Forty will certainly continue to ride again and again and again.

Truss also pledged "I will make sure people can get doctors' appointments and the NHS services they need. We will put our health service on a firm footing".

I mean, that's vague.

Blackpool Tower's on a firm footing, but it's probably not a great health system.

Likewise, I suspect you might find the definition of the word 'need' will become seriously elastic.

Under conventional economics here in the real world, more doctors' appointments (and PM Truss essentially means GPs) requires more doctors. We do not have them: GPs are planning to leaving the profession, or leaving full-time work, in droves and at the rate of knots (this is autumn 2022's 'scale and pace').

The latest data shows that "the proportion of GPs in England working full-time at local surgeries has fallen to the lowest level since current records began five years ago ... nearly a quarter (23%) of qualified permanent GPs worked at least 37.5 hours a week in June 2022, down from almost a third (32%) in June 2017. The number of family doctors working full-time hours or more has dropped in the same period from 10,740 to 8,207."

Peaux fragiles

One must have a heart of stone not to laugh at the thin-skinned nature of The Surgical Reign, with The Independent being briefed that comedian Joe Lycett's ironic support for La Surgical on the BBC's new 'Laura Kuenssberg Show' had royally pissed off Team Liz.

And this imperiousness was before they had even been confirmed winners.

The next couple of years are going to be delicious.

A note on presentation

It became explicit at her inaugural PMQs that PM Truss is trying to do a Margaret Thatcher with her voice: going deep and slow for authority.

Unfortunately, with La Surgical, it’s not only inauthentic, but worse, inconsistent. When Truss has a sub-thought, or improvises a bit that veers off her brief/script, she drops it.

Whatever else she was, Mrs Thatcher was a pro: when she made so big a change to her presentation, she put serious hours in before unveiling it in public.

This feels a lot like a 'tell' about La Surgical, and I suspect that's exactly what it is.

The ability to count

The currency market's faith in Team Surgical's "delivery, delivery, delivery" mantra seems less than wholehearted. It remains to be seen how gilts and sterling will be affected by the Government's energy crisis response (eschew windfall tax, borrow more money and make customers pay it back, basically), but it may not be well.

This will affect the costs of public borrowing, and thus public spending.

A Scholar and a gentleman

The new Government's reputation for economic competence took another blow when new Chancellor Kwasi Kwarteng dismissed Treasury permanent secretary, the able and experienced Tom Scholar.

Former Treasury permanent secretary Nicholas Macpherson's response to this news was to the point:

The only Chancellor never to deliver a Budget (and post-Alan Health Secretary) Sajid 'The Saj' Javid also weighed in, with what can be read as implied criticism:

More numbers

To the considerable surprise of absolutely nobody who's been paying attention, the latest RTT waiting times data revealed that yet another 100,000 people had joined the backlog in the past month - as has been the case of each of the past months for A Long Time Now.

The RTT backlog thus hits a new record total of 6.8 million people waiting for NHS care.

In January 2020, before Covid19 hit, the RTT waiting list was 4.4 million. The 30 months since then (many of them, of course, affected by the pandemic) would have taken the RTT backlog total to 7.4 million if it had been 100,000 every single month, so we should be grateful for small-ish mercies.

The data also showed that last month, nearly 29,000 people waited more than 12 hours to be treated in A&E once a decision had been made to admit them: almost 500 fewer than in July 2022 (but still ten times higher than this time last year).

They also reveal that cancer targets are still being missed: 71 per cent of suspected cancer patients were diagnosed or had the disease ruled out within 28 days – lower than the national target of 75 per cent.

There was some proper good timing from Nuffield Trust and Health Foundation's Quality Watch latest, which examines the role of Covid19 in the NHS's current parlous state. (Spoiler: it played a role, but very much not the major role, contrary to the last Government's attempted narrative, which the current Government is clearly trying to perpetuate.)

Wake up and smell The Coffey

Oh God. New SOS, anti-abortion Dr Therese 'Tiz' Coffey has set out her ABCD priorities - ambulances; backlog; care; doctors, dentists and osteopaths.

Aren't you reassured? And reassured that 'Tiz' is bringing to DHBSC three of her SpAd from her last department, DWP?

And that Number 10's new health SpAd is Caroline Elsom, who also worked with Dr Coffey at DWP?

Yep, me too.

Reassured, reassured, reassured. Couldn't be reassured-er if I tried.

A medical echo

There is a notable and potentially pertinent point about Dr Coffey's personal history, revealed by Andrew Pierce in the Mail. "In 2018, Coffey picked up an ear infection and, despite being prescribed an antiseptic spray by a GP, her condition deteriorated sharply. Within hours of arriving at A&E at a local hospital she was in the operating theatre.

"The infection spread to her brain and she was diagnosed with meningitis, staying in hospital for a month. At times, she had difficulty forming sentences and suffered memory loss."

For those with long memories, it is impossible not to recall Andrew Lansley's experience of having had an initially undiagnosed stroke in 1992, which he revealed to The Spectator in 2006.

'Honest Bob' Jenrick is Health Minister

'Honest Bob' Jenrick - famous for taking a bribe, sorry, 'donation' over a planning decision and for breaking lockdown rules - is the new Health Minister.

Westminster speculation suggests that Dr Coffey's other job as Deputy Prime Minister will leave 'Honest Bob' as de facto SOS for Health But Social Care.

That is not a positive prospect.

Other new ministers include the able and bright Neil O'Brien; and Will Quince, expected to lead on social care. HSJ's Henry Anderson spotted this Neil O'Brien Conservative Home piece from the summer, which points out that high inflation means that the NHS will need more money.

'Did NHS England Actually Let That Happen In The Real World?' Of The Week: 'What If We Were Salmon?' remix

I'm grateful to Dr Fergus O'Farrell for spotting this gorgeous workforce initiative from NHS England: an organisation that is clearly hell-bent on making itself politically un-abolishable.

In the NHSE online 'Wellbeing Festival' this week, one of the topics under consideration in an organisation meant to be directing a service with 126,000 full-time vacancies (as discussed last week), one of their highlighted topics - alongside 'Workout with Mr Motivator!' - is "What if we were salmon?"

What, indeed, if we were salmon? Eh? What would that make us?

A food commonly served to vegetarians?

Creatures that swim upstream through rivers full of shit?

Food for thought, indeed. I'm grateful to the creators of this NHS England online 'Wellbeing Festival' for bringing a new dimension of ridiculousness to the world of health policy.

Not even the great Julian Patterson could have come up with this. Those responsible are clearly geniuses of the highest order, and 'Cut' salutes them.

The Barclay nonsense

It is perfect justice that Steve 'The Banker' Barclay came in to the health brief like an inefficiency-seeking lion and left like an internationally-recruiting lamb.

His plans briefed to The Guardian (now that's going native) was to try to deal with some of the workforce crisis with more immigration.

Spectator political editor (and Rishi Sunak's best man) James Forsyth wrote that Barclay's efforts to achieve traction on workforce and pensions issues with the Treasury Munchkins failed: "Barclay sent half a dozen letters to the Treasury setting out potential solutions to these problems — but progress came there none".

Axiomatically, all political careers end in failure - but The Banker's has done so a bit more ironically than most.

Hopson's choice: Cassandra turns Pollyanna

Many readers may remember a time when an outspoken leader of the NHS Providers representative pressure group would rail against Government cant disguising the truly bad current state of the NHS in 27-Tweet threads. And that would be on one of his more laconic days.

His name was Chris Hopson. (And yes, OK: I did teach Chris how to use Twitter. You win some, you lose some, and then there's that third category ...)

In an heroic reverse ferret, a certain Chris Hopson, now chief strategy officer for NHS England, railed against the “overwhelmingly negative narrative” about the NHS.

I wonder whether these two Chris Hopsons are by any chance related?

Chris' transubstantiation from Cassandra to Pollyanna is complete. It's wonderful! (Blink twice if you're still in there, Real Chris! We'll send Norman Vincent Peale ASAP.)

Pollyanna-Chris went on to reveal a new scale for NHS achievement: 'The Chris Hopson Feels Index’. No, I’m not even joking: HSJ's Alison Moore reports that P-C “said that compared to other developed countries’ health systems, “our outcomes are probably in the middle but hopefully heading to higher” …”.

"Hopefully" is not a plan.

Chris' NHSE job title is, as I exclusively revealed back in May, chief strategy officer.

So, is this NHS England's strategy?

Sadly, yes it is.

It's not good strategy, of course. But once you're up a certain creek with neither paddle nor plan, attempts at 'comms-ing it' - no matter how laughably counter-productive, such as this one - are all you've got left.

Moreover, having now been in post for over a year, NHS Pope Amanda Pritchard has become politically mortal over the NHS's performance. That clearly played in to the 'hire Hopson' decision: the old 'inside the tent, pissing out' approach.

"Eternal Sunshine Of The Spotless Mind grant unto them, O Lord ..."


I'm not really sure about giving EveryGrifter the publicity of a regular slot, but this proposal from their leader, political campaigner 'Dr' Julia Grace Patterson, who runs the private company that is EveryGrifter, is certainly bare-faced.

Cronyvirus and Coronamilions update

It feels like there may be more to come out on the relationship between Liz Truss and Andrew Mills of Ayanda Capital (failed face-mask provider under a VIP fast-lane contract).

Good Law Project founder Jolyon Maugham points to Mills' tenure as an advisor to the Board Of Trade and to Ayanda.

John McTernan, political strategist and former political advisor to Tony Blair, wrote this excellent summary of what is needed to run an effective 10 Downing Street operation for the FT. Rachel Wolf of Public First, a principal author of the 2019 Conservative manifesto, added these reflections on the same theme.

"I'm excited about a new bulb with a specific wavelength of light that sterilises surfaces. It costs $1,000 now, but with enough R&D we could get that down to a dollar. . . If we had building regulations that required these to be installed everywhere, like we require chlorine in water, we could have sterilised air and get rid of diseases.” Fascinating William MacAskill Lunch With The FT

New research seems to indicate that the Galleri Test, currently being piloted with 165,000 NHS patients, is a simple blood test that can spot multiple cancer types in patients before they develop clear symptoms.

Theranos founder and convicted fraudster Elizabeth Holmes hopes to appear against her conviction.

The charity Engage Britain has briefed a story to the Guardian that "one in 10 (10%) adults in the UK have turned to the private sector or independent healthcare in just the last 12 months, according to a survey commissioned by charity Engage Britain. Of those, almost two-thirds (63%) did so because they faced long delays or could not access treatment on the NHS." Seems a very high number to me?