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Cowper's Cut 285: Stable doors and bolted horses

Cowper's Cut 285: Stable doors and bolted horses

Consultants strike; plan further strikes

Intriguingly, this week's consultants strike attracted relatively little media coverage beyond a few poor-quality articles about how much consultants earn.

Nick Triggle's BBC News piece was particularly poor, cherry-picking as it did salary data from this nuanced and sensible Nuffield Trust piece.

Exploring the earnings of NHS doctors in England
In this explainer, we look at how doctors’ pay in England has changed over time, how it compares to other salaries in the wider economy, and how it compares with what doctors in other countries are paid.

August is over. This means that the Government has now blown its opportunity for a maybe-less-media-covered Silly Season climbdown in the industrial dispute over pay.

So the industrial action will go on and on.

So the Government will reap what they sow, in the forms of a further-growing RTT backlog and a nailed-on appalling winter. Again.

And unfortunately, so will the rest of us.

The inevitable corollary was that the BMA consultants' committee announced a further strike, this time for three days 2-4 October, during the Conservative And Unionist Party's Conference.

Labour attack PM's special advisor for his former agency client's backlog contracts

Private firm linked to No 10 adviser handed NHS waiting lists contract
Labour accuses Rishi Sunak of possible conflict of interest as former client of Bill Morgan chosen to run diagnostic centres

Labour's shadow social care minister Liz Kendall accused the PM's health special advisor Bill Morgan of having a conflict of interest regarding private sector provider InHealth (a client of Morgan's former agency Incisive Health) having won a waiting list backlog contract.

Leaked to The Guardian, Kendall's letter to health minister and Elective Recovery Taskforce chair Will Quince "questioned what measures were taken to manage potential conflicts of interests when the contracts were awarded, and whether Morgan was required to declare his past connection to InHealth when taking the No 10 job".

Stable Door Closure Post-Horse-Bolting Award Of The Year

"All NHS organisations are reminded of their obligations under the Fit and Proper Person requirements not to appoint any individual as a Board director unless they fully satisfy all FPP requirements – including that they have not been responsible for, been privy to, contributed to, or facilitated any serious misconduct or mismanagement (whether lawful or not). The CQC can take action against any organisation that fails to meet these obligations."

NHS England's heroic letter to leaders about the Countess Of Chester serial killer paediatric nurse is a communication that should not be tossed aside lightly, but hurled with great force.

What has since happened to the members of the North-West regional presence of NHS England? How involved were NHSE regionally and nationally in the moving-on of the COC senior management team, once the police investigation revealed what it did?

Threatening people with the same CQC which rated COC as 'good' during the serial killing? Yes, that'll work.

Isabel Hardman's Spectator piece on the NHS's dysfunctional (or should that be all too functional?) bullying culture is well worth your time.

NHSE calls urgent meeting over powers to strike off managers
Amanda Pritchard has said it is time to “look again” at whether NHS England should be given formal powers to disbar managers for “serious misconduct”.

Fantastically, NHS England achieved Peak NHS England by calling an "urgent meeting" to discuss regulation of NHS managers in the wake of the Countess Of Chester paediatric serial killings.

As chief NHS satirist Julian Patterson wryly noted, it is "hugely amusing that NHS England thinks bad management will be cured by 1) a meeting, and 2) NHS England".

A trip down nostalgia lane

Cowper's Thirty-Second Law Of Healthcare states that for every action, there is an equal and opposite over-reaction. Thinking about the fallout from the Countess Of Chester serial killer paediatric nurse, I took a trip down nostalgia lane to 2015, and 'The Case For Patient Safety': a special report I wrote for HSJ sponsored by Allocate Software (for whom I still do some consultancy work).

The Case for Patient Safety: Financially, Professionally and Ethically
Read the full report

It's aged quite well, really. I remember thinking that both that and the HSJ/Serco Commission For Hospital Care Of Frail Older People were quite substantial contributions. I suspect the latter had some influence on the period's policy nostrums/myths about further cutting hospital beds and likely significant and cashable financial savings from improved care.

Certainly, 'The Case For Patient Safety' report's arguments for safety systems and just, transparent culture had what we might politely call a limited impact.

The GMC make themselves a laughing stock yet again

There must be a formal contest between the Academy Of Medical Royal Colleges and the General Medical Council: a ridiculousness-off. No other explanation befits the GMC's efforts to overtake the AOMRC's remit-free industrial action 'interventions', which so effectively ended all the NHS industrial disputes over pay in one fell swoop.

Oh ...

Well, perhaps one other explanation fits:  the chief executives of the GMC and AOMRC both want to show their suitability as the next NHS England CE. High levels of blatant ridiculousness are a core competency.

The new GMC Good Medical Practice 2024 guidance document contains much that is both sensible and worthy, but in the current environment (both post-COC serial killer and the broader NHS utter chaos), their proposed new 'duty of be kind' is a particularly crass bit of simpering.

It requires that doctors "must treat colleagues ('colleagues’ includes anyone you work with, whether or not they are a medical professional) with kindness, courtesy and respect. To develop and maintain effective teamworking and interpersonal relationships you must:

  1. listen to colleagues
  2. communicate clearly, politely and considerately
  3. recognise and show respect for colleagues’ skills and contributions
  4. work collaboratively with colleagues and be willing to lead or follow as the circumstances require."

Have you met doctors and nurses, the GMC? I've met a few: even seem some at work. Some of the strongest teams would be disbanded in an instant if this were enforced. I'm reminded of the NHS manager Gary Walker, allegedly sacked for swearing.

And this is a "must" duty; not a "should".

This 'duty of be kind' is going to be about as effective as the 'duty of candour' was: the NHS has been absolutely famous for its candour since 2015. Internationally noted for it.

Only simpering 'be kind' can save us now, it seems. Perhaps a 'duty to live, laugh, love' is up next.

The Alan intervention

Matt Hancock: How can we stop the revolving door of failed NHS managers?
There should be a full statutory inquiry into the Lucy Letby case, the former health secretary writes

The People's Partridge treated us to his wisdom on managerial regulation in this piece for The Times. In this classic  of the 'oh my'-ist genre, The People's Partridge asks, "how can we change the culture of the NHS to be transparent and bring problems out into the open, so people can speak up instead of being shut down?

"How can we stop the revolving door of failed NHS managers in a way that doesn’t make it harder to bring in outside talent, which is often part of the solution to poor management?"

There may be people to whom we should listen less than Alan on this topic, but there are not many.

Hancock delays decision on new NHS management regulator
The government has delayed making a decision on whether to introduce a regulator for NHS managers, after a review recommended those guilty of misconduct should be barred from sitting on NHS boards.

Alan's Damascene conversion to regulating managers sits in sharp contrast to his response to the Kark Review of the 'Fit And Proper Person Test' in 2019, when Shaun Lintern's Health Service Journal piece reported that he "announced the government would accept only two of seven recommendations made by Tom Kark QC following his review of the fit and proper person test.

"The two accepted recommendations include the development of new core competencies for NHS directors and the establishment of a central database of information about directors’ experience and previous employment, including disciplinary and grievance issues."

In 2019, The People's Partridge told Shaun, “I can see the attraction and the opportunities we will get from being able to ensure we have a system in place where if somebody has demonstrated behaviour that is unacceptable that action such as striking off their ability to be a director can be taken.

“We have to get it right because at the same time we also need to be able to encourage more people and people of great calibre into positions of leadership within the NHS. So getting the balance right so that this strengthens the system and encourages people in is what I would be looking for.”

EveryGrifter update

I feel sure that all 'Cut' subscribers will share my grief at learning that EveryGrifter are finding that the grift is getting to be slightly harder work.

NHS 'campaigner' 'Dr' Julia Grace Patterson writes, "why is it getting harder and harder for progressive campaigners to speak to people on Twitter? Many of us are losing followers or some of our posts aren’t visible.

"It’s a huge problem."

Of course it is. I can conceive of few huger problems than the fact that credulous people are - at very long last - stopping funding EveryGrifter's utter nonsense.

Necessary and timely BMJ piece on lessons not learned by Professor Alison Leary.

Dr Michael Lambert's piece '75 Years of the NHS – reform, reorganisation and restructure' https://thehistoryofparliament.wordpress.com/2023/08/22/75-years-of-the-nhs-reform-reorganisation-and-restructure/

CarnallFarrar report for NHS Confederation on how NHS spending can drive economic value. https://www.carnallfarrar.com/the-influence-of-nhs-spending-on-economic-growth/

HSJ reports that a consultancy run by a former partner of a health minister has been awarded a contract to work for the New (If Fictional) Hospitals Programme.

The Financial Times reports on how using the blue blood of horseshoe crabs to test vaccines and medical devices is coming under fire, with environmentalists and a large European investor putting pressure on pharmaceuticals groups to seek alternatives.

Anjana Ahuja FT piece on the possible promise of a new resistance-proof antibiotic.

Useful new BJGP paper from Zhao, Meacock and Sutton on 'Population, workforce, and organisational characteristics affecting appointment rates: a retrospective cross-sectional analysis in primary care'

Piece by Professor David Oliver on what we can learn about NHS management culture from almost all comments on HSJ stories being 'anonymous'.

My latest column for the Pharmaceutical Journal