If you're launching The War Of The NHS Narrative, as the Government clearly has, then you probably don't want its arrival to be heralded by the fact the Prime Minister Rishi 'The Brand' Sunak uses a private GP service that charges £250 for a half-hour consultation.
£250 is, as primary care manager Craig Nikolic pointed out, about twice the sum an NHS GP practice gets per year for a single patient: a fact worth bearing in mind when we consider the primary care data dump that followed on Thursday.
It gives an Austerity 2.0-hit public an unwelcome reminder of the PM's huge personal wealth, and of how it insulates him from the state of the public services that he runs.
The politics of the narrative
Health Service Journal's Dave West spotted that the very day after Steve 'The Banker' Barclay's attempted assault last Sunday on 'wasteful NHS bureaucracy', the Department For Health But Social Care is attempting to drive some new funding through the medium of ... you guessed it, 'wasteful NHS bureaucracy'.
In Dave's words, "the day after promising a bonfire of targets/reporting/bureaucracy, the DHSC issued this - a reporting regime for a dollop of money dropped from the centre at a few weeks notice, and worth 0.3% of the total NHS budget".
The Government thinks that it's going to get itself off the hook for neglecting NHS performance for the best part of a decade, using the 'wasteful bureaucracy' alibi.
Not like this, they're not.
The relaunch credibility problem
The Government has a sizable relaunch credibility problem.
By the likely date of the next General Election, the Conservative And Unionist Party will have been leading the Government for just shy of fifteen years.
Mr Sunak was Chancellor for the bulk of the Boris Johnson premiership, which cuts his plausible deniability of responsibility down to pretty much zero. And his Chancellor Mr Hunt was the longest-serving Health Secretary in history.
They are absolutely going to wear responsibility for the state of public services at the next General Election.
This is why they are trying desperately to change The Narrative.
I have been pointing out in these columns for some time now the wave of hard-of-thought attacks on the NHS by the political right, from the self-identifying 'think' tanks and the usual suspects in the right-wing press. HSJ's editor Alastair McLellan wrote this neat summary of the general style of these pieces (which was commissioned but rejected by two right-wing publications).
What's going on is straightforward: the political right has a lot of friends who own newspapers and think-tanks.
The health editor of a national newspaper (whom I'm quoting here under the Chatham House Rule) put it this way: "the Government is going to continue trashing the NHS between now and the next election, because it can’t do anything else. To do so would be to admit negligence/culpability for what has happened on their watch over the past 12 years.
"So expect the narrative to get much, much worse over the next two years".
I wouldn't really call it a strategy, but it's pretty consistent with what is under way.
As the Financial Times outlines, the NHS in particular and the public sector overall are struggling badly due to the austerity decade, and compounded by the now-clear economic impacts of Brexit, and the Covid19 pandemic made matters much worse.
The evidence is as overwhelming as it is undeniable.
Facts and figures
The Department For Health But Social Care have been prompt to press release the latest NHS workforce increases, and the 1 December vacancies data should be telling. Because refilling a workforce bucket that is still leaking badly when you don't even understand why it's leaking is ... sub-optimal.
Amusingly, this press release's quote mentions that "a record number of doctors and nurses are working in the NHS in England, delivering extra appointments, speeding up diagnoses and helping to tackle the COVID backlog". The current RTT backlog of 7.1 million was already 4.4 million before Covid hit: is the DHBSC ambition for these new staff merely to get it back down to that level?
And as for the comment about speeding up diagnoses, it's worth looking at this FOI response from NHS Resolution about "failure/delay" diagnosis legal claims in the case of cancer.
The numbers are a bit terrifying.
It is perhaps optimistic to believe that facts and suchlike may influence The Narrative, but Gold bless the House Of Commons Library for this helpful Research Briefing on NHS waiting times.
Friends to the rescue!
As you can see from the Daily Mail and Boris Johnson Fanzine articles on the aforementioned new primary care performance data, on primary care performance : the Boris Johnson Fanzine's hilariously confused editorial is perfectly on-brand in its 'pro-having cake, and pro-eating it' vibe.
These come as the glacé cherries and 'hundreds and thousands' on top of a long series of articles attacking primary care in particular, and the NHS in general in these and other right-wing newspapers.
After months and years of repetition, even relatively clever people start to buy in on The Narrative. Institute for Fiscal Studies director Paul Johnson blithely asserts in a Times comment piece that “we can all see how badly run the NHS is”.
Erm, some data or evidence that the state of the NHS is because it's badly-run, please? I understood evidence to be an IFS thing.
It's also well worth reading this thoroughly odd column from Mail regular Tom Utley, about his getting what by current standards is reasonably prompt treatment in A&E (7 hours, the last 1.5 of which unnecessarily) in response to an abnormal blood test.
Utley concludes "Could it be — I’m just asking — some family doctors are over-keen to refer patients to A&E, simply to cut their own workload and cover themselves against the possibility of a court case if anything should go wrong? In the interests of reducing those waiting lists, should doctors be given more freedom to trust their instincts — and to skip any time-consuming procedures they deem unnecessary — without the risk of litigation if things go wrong?"
Medical 'truthiness' is clearly very much A Thing for Mr Utley.
With friends like these who own newspapers, the Government must wonder, who needs enemies?
Conservative political fortunes
Isabel Hardman's clear-eyed summary for The Observer sets out what the Conservative And Unionist Party will have to boast about at the next General Election (when the Jeremy at issue will be Hunt, not Corbyn).
The 'chicken run' of Conservative MPs deciding not to stand again is well under way.
Anita Charlesworth's reflections in HSJ about the temporary reprieve from the Autumn Statement budgetary boost is also pertinent.
RCN strike dates 15 and 20 December
The industrial action planned by the RCN for 15 and 20 December will allow the right-wing press to step their Government support up several gears in The War Of the NHS Narrative.
The Future Health organisation, run by Alan's former SpAd Richard Sloggett, released analysis reported in The Guardian on the regional impact of the strikes: "those living in the south-west of England, the north-west and London are most likely to have their care disrupted, according to analysis by the Future Health research group. That is because almost all the acute hospitals in those regions will face industrial action by nurses in pursuit of their 15.1% pay claim and also because they have large numbers of patients waiting to have a joint replacement, cataract removal or other procedure".
The court of public opinion
How will public opinion receive these strikes?
The latest data from the Ipsos Veracity Index shows that nurses are the most highly-trusted profession. Their claim of a 19% pay rise is obviously somewhat bold, and definitely a help to their opponents.
NHS matters are comfortably third in the latest Ipsos Issues Index poll, but it has not yet got genuinely cold. It is likely to do so.
NHS management is certain to be attacked with The Narrative.
Yet for all Health But Social Care Secretary Steve 'The Banker' Barclay's rhetoric about decentralising, as Dave West pointed out above, the habits of central micro-management run very deep indeed. And you can't do central micro-management without a manger class.
As if by magic, what does The Boris Johnson Fanzine lead with today? NHS manager-bashing based on pay. GPs will recognise this rather limited anti-capitalist playbook.
It’s dull that we’re going to need to have this fight again, but we are.
The reason why?
The Government has allowed NHS performance to deteriorate so seriously over the past decade. The new CIPFA/Institute For Government report finds that "funding for the NHS is unlikely to be sufficient to return performance to pre-pandemic levels, especially in hospitals where elective backlogs are likely to remain far above where they were in 2019. It is also very unlikely that the NHS will be able to resolve its recruitment and retention problems with the funding allocated in the autumn statement".
Read Tim Adams' excellent Observer piece about the huge, real pressures in general practice.
The Government now desperately need an alibi, and ‘wasteful bureaucracy’ is among their early choices.
There are some good ideas available, such as those in Nigel Edwards' Twitter thread below, but thus far, The Banker Barclay shows no inclination to follow them.
I touched on The Banker's rhetorical commitment to devolution above.
This letter to the health and care sector from Social Care Minister Helen Whateley brings us a delightful new piece of health policy jargon: a “National Discharge Frontrunners programme”.
La Whateley sets out "details of the £500 million Adult Social Care Discharge Fund (“the Fund”), which was announced as part of Our Plan For Patients on 22 September", adding with just a hint of acerbic camp, "I know this has been much anticipated since it was announced".
'National Discharge Frontrunners'. Mmmmmmm. Someone had best go and score some unprescribed antibiotics from Dr Tiz to clear that up, no?
Actuary Stuart McDonald notes that "ONS deaths data has been released for week ending 11 November: 1,207 more deaths were recorded in-week, compared to the 2015-19 average. That’s 12% more, which is another significant excess.
"Year-to-date there have been 494,397 deaths recorded, which is 8% more than the 2015-19 average".
Freedom Of Information
FOI frequent filers may be amused by the below from Times journalist George Greenwood:
Cronyvirus amd coronamillions update - 'peer pressure' special edition
I'm aware that this section has annoyed some readers and bored others, but sometimes you have to keep following a thing.
As The Guardian has, in the case of Tory peer Baroness Mone.
This week, the intermittently-very-annoying paper of the UK liberal left wrote that "the Conservative peer Michelle Mone and her children secretly received £29 million originating from the profits of a PPE business that was awarded large government contracts after she recommended it to ministers ...
"Lady Mone’s support helped the company, PPE Medpro, secure a place in a “VIP lane” the government used during the coronavirus pandemic to prioritise companies that had political connections. It then secured contracts worth more than £200 million.
"Documents seen by The Guardian indicate tens of millions of pounds of PPE Medpro’s profits were later transferred to a secret offshore trust of which Mone and her adult children were the beneficiaries.
"Asked by The Guardian last year why Mone did not include PPE Medpro in her House of Lords register of financial interests, her lawyer replied: “Baroness Mone did not declare any interest as she did not benefit financially and was not connected to PPE Medpro in any capacity.”
"The leaked documents, which were produced by the bank HSBC, appear to contradict that statement. They state that Mone’s husband, the Isle of Man-based financier Douglas Barrowman, was paid at least £65m in profits from PPE Medpro, and then distributed the funds through a series of offshore accounts, trusts and companies.
"The ultimate recipients of the funds, the documents indicate, include the Isle of Man trust that was set up to benefit Mone, who was Barrowman’s fiancee at the time, and her children. In October 2020, the documents add, Barrowman transferred to the trust £28.8m originating from PPE Medpro profits.
"That was just five months after Mone helped PPE Medpro secure contracts to supply masks and sterile gowns for use in the NHS".
This story has evidently been 'legalled' to within an inch of its life, and still met the standard required for publication. There is what seems like a strong ‘bang to rights’ vibe here.
To be entirely clear, and for the avoidance of any doubt, I am in no way suggesting that the noble Baroness et al are so bent that you'd need a corkscrew to put them under.
Doubtless, Baroness Mone will want to take strenuously prompt and highly decisive legal action to absolutely and irrefutably clear her name. And will not merely threaten to do so, like a fourth-rate paper tigeress.
In the interests of balance and fairness, we should feature Baroness Mone's detailed and forensic rebuttal of the charges:
The Commons Urgent Question debate on this issue is well worth reading. Health Minister Neil O'Brien drew the short straw of responding to Angela Rayner's effective attack.
Rayner's speech stated that "in May 2020, PPE Medpro was set up and given £203 million in Government contracts after a referral from a Tory peer. It now appears that tens of millions of pounds of that money ended up in offshore accounts connected to the individuals involved—profits made possible through the company’s personal connections to Ministers and the Tories’ VIP lane, which was declared illegal by the High Court.
" Yet Ministers are still refusing to publish correspondence relating to the award of the Medpro contract, because they say that the Department is engaged in a mediation process.
"Can the Minister tell us today whether that mediation process has reached any outcome, and what public funds have been recovered, if any? Will he commit to releasing all the records, both to the covid-19 public inquiry and to this House, once the process is completed?"
Mr O'Brien did not properly answer these questions, stating only that "we have not got to the point where a satisfactory agreement has been reached at this stage". Ian Lavery, an MP for whom one should normally have little time, made the good point of asking "at the same time as the Government were being obstructive and deliberately attempting to block Northumbria Healthcare NHS Foundation Trust in the north-east from providing PPE from a factory of its own, people who were closely connected to the Government were making millions from PPE. Minister, is that just a strange coincidence?"
Again, there came no pertinent reply.
The Guardian's indefatigable David Conn has pivoted to look at Michael Gove's apparently contradictory explanation of how he referred Baroness Mone's offer of help from the at-that-time-unincorporated company PPE Medpro.
And the FT has more details of the financial trail.
Under criminal investigation
Meanwhile, the Lords Standards Commissioner's website announces that among the peers currently under investigation is "Baroness Mone – Alleged involvement in procuring contracts for PPE Medpro leading to potential breaches of the following paragraphs of the House of Lords Code of Conduct: 9 (a), (b), (c), (d); 12 (a), (b); 16".
The Commissioner further states, "in accordance with paragraph 144 of the Guide to the Code of Conduct, the Commissioner is unable to finalise or publish any report into the conduct of Baroness Mone while the matter is under investigation by the police or another agency as part of a criminal investigation.
"Once any criminal process is complete or has ceased, the Commissioner will complete his investigation and publish his report".
You can't keep a good businessman down, and you can't keep Babylon founder and Circle Health failure Aloytius Parsadoust down either, as this laughable FT interview shows.
Aloytius says that Babylon’s stock market performance since going public last year was an “unbelievable, unmitigated disaster” that required a significant restructuring of the business. One must have a heart of stone not to laugh.
You want more pearls of wisdom from The People's Parsadoust? Why, of course: "we learnt a big lesson, which is we should have done a lot more thinking through SPACs ... unlucky at the time, or we made the wrong decisions, but now we fix it”. Go on then, Aloytius. Fix it. We're watching.
The article reports (as 'Cut' has been noting was required for some months now) that "in September, the company received notice that it violated NYSE rules that require listed companies to maintain an average closing share price of at least $1 over a consecutive 30 trading-day period. As a result, Babylon has issued a reverse stock split, where existing shares are consolidated into fewer, higher-priced shares, due to complete in December before the notice period expires and it is kicked off the exchange".
What a relief that Mr Parsadoust has no obvious tradition of destroying shareholder value ... oh.
Despite their NHS business model being to attract young, healthy and tech-savvy patients, Aloytius asserts that "we still lose money on every patient. There is a structural problem. The NHS doesn’t have enough funds itself . . . services do not get paid enough and therefore [it is] really hard for companies to make [it] work economically”.
Oddly enough, most UK private sector providers are doing really well. What could it be about Babylon/GP At Hand? Or about Aloytius?
Dear old Aloytius: someone's advised him that a masochism strategy is worth trying. Maybe it was his chum Alan?
Speaking of whom ...
The Alan comeback
Is it over yet?
Ah yes, it is. Alan The Third. He'll be furious.
The Guardian has a piece on Alan's PR team (Hi, Gina!) using TikTok to drive support for him.
Next stop, SAS: Who Dares Wins. We are not worthy.
Recommended and required reading
Dispiriting but good Financial Times piece about the deepening mental health recession.
To balance the above, very nice FT piece on how Cambridge University Hospitals is coping with the ongoing situation. Not losing The War Of The NHS Narrative will need the NHS to get much better at placing or suggesting features like this.
The Institute For Government's 'Week In Public Services' remains a quality read.
Sky News economics editor Ed Conway has a brilliant explanation of the scale of government debt that the gilt market's being asked to buy in this Times article.
Axel Heitmueller and Mark Kewley comment piece in HSJ on the importance of the NHS working effectively with industry to rebuild.
The Institute for Cancer Research has this piece in The Times about potential new combination treatments.