18 min read

Cowper’s Cut 326: D-Day (as in debate) offers little clarity

Cowper’s Cut 326: D-Day (as in debate) offers little clarity

Bob The Whippet’s emotional support human and Secretary Of State For The Next Four Weeks Victoria Atkins was once again trying hard to avoid reality at the start of the week, with her assertions that voting Labour will lead to industrial action.

Given the NHS industrial action we have seen over the past couple of years, this is a bold claim. One might even call it courageous.

Her attempt to iterate it on Kiss (formerly Twitter) with the slogan vote Labour, get strikes attracted the attention of members of the Reality-Based Community, who amended Mrs Atkins’ smooch with the following Community Note: “Under the last Labour government, there were 0 national NHS strikes. Under the current Conservative government, there have been 3 national NHS strikes (2014, 2015-16, 2022-present).”

Mrs Atkins further entertained a grateful health policy nation when she asserted that she has a “clear plan to build or modernise 250 GP surgeries”. This is rather mauve of her, given that the alleged funding for these exciting new fictional bits of infrastructure will be found by cutting NHS management back to its pre-pandemic levels.

I laughed until I stopped when I saw Mrs Atkins’ self-identifying “clear plan”. It is universally agreed by people with any idea what they’re talking about that poor and insufficient management is a huge part of the NHS’s performance problems.

In defence of NHS managers: a response to the Conservative plan to cut 5,500 posts
A look at the value of managers in the NHS – and what is needed to improve their experience.

The mindless manager-bashing underlying Mrs A’s assertion was ably debunked by this response from the Health Foundation.

The extent to which this should be taken seriously can be gauged by the Conservative And Unionist Party’s New (If Fictional) Hospitals Programme. Mrs Atkins is attempting to retail untruths here. Members of the Reality-Based Community will treat it with due seriousness.

They will be just as impressed by Mrs Atkins’ attempt to pretend that “Labour has a No New Hospitals Plan to pause and delay all capital projects in the NHS”.

Dear readers, no such plan exists here in The Real World.

New Hospital Programme admits 50% vacancy rate amid recruitment problems
The New Hospital Programme team has faced issues recruiting to internal roles and recently had a 50 per cent vacancy rate, the government has admitted.

But God bless Mrs Atkins for reminding us that the Conservative And Unionist Party’s New (If Fictional) Hospitals Programme is going so well.

‘40 new hospitals’ programme is £4bn short, say officials
The government’s flagship programme to build “40 new hospitals” requires another £4bn to complete the schemes by the end of the decade, according to officials.

It is A Triumph.

Fears of delay to flagship ‘new hospitals’ after funding cut
Several of the ’40 new hospitals’ promised by government face further delay and disruption because the trusts are receiving less cash than needed for crucial planning work this year, HSJ can reveal.

One can only hope that she will mention it much more often.

Fears of delay to flagship ‘new hospitals’ after funding cut
Several of the ’40 new hospitals’ promised by government face further delay and disruption because the trusts are receiving less cash than needed for crucial planning work this year, HSJ can reveal.

Industrial actiooops

Mrs Atkins may think of herself as something of a social media ‘Ninja’, with her post amplifying PM Sunak’s claim in the debate (see next) that Labour leader Keir Starmer cannot say how he would end the junior doctors’ strikes.

She asserted on Kiss (formerly Twitter) that I’ve been in the room with Junior Doctors … I would stand up for taxpayers and patients. It’s called leadership.”

This would perhaps have worked well, but for two things.

Government explores mediation with junior doctors committee
Both parties have agreed a preferred mediator - the union and the government will now begin the process of engaging with them.

Firstly, it is a matter of the Government’s own record that Mrs Atkins’ attempts at being in the room with the BMA junior doctors committee leaders were so useless that mediators had to become involved.

Secondly, live by the Kiss, die by the Kiss: BMA JDC co-lead Vivek Trivedi popped up in response on Kiss to reply, True, you have been in the room. It’s where you told us you were more afraid of what the Daily Mail readership would think rather than actually trying to resolve our dispute.

“Stellar leadership.


D-Day: the head-to-head leaders’ debate

This week saw ITV host the first of the two debates between PM Rishi ‘The Brand’ Sunak and Labour leader Sir Keir Starmer.

This event had a terrible format (the men trying to answer questions in 45-second bursts), and was weakly hosted by Julie Etchingham.

There was some health stuff, but it was not wildly enlightening. Asked a question about how long it would take to fix the broken NHS, both men gave bland, boilerplate responses.

These led to a dispute over the RTT waiting list numbers, which Starmer noted (correctly) have gone up since Mr Sunak’s pledge to reduce them. Mr Sunak’s reply, that “they’re coming down because they were coming down from where they were when they were higher”, drew laughter from the audience.

Honours were evened out when Mr Sunak challenged Mr Starmer to say how he would resolve the junior doctors’ 35% claim for full pay restoration. Mr Starmer talked about getting in the room and negotiating: Mr Sunak responded that paying the 35% claim would put up voters’ taxes: this won him a laugh from the audience.

Host Julie Etchingham asked both leaders a ‘quick-fire question’ on the topic: whether they would use private healthcare if a loved one were on a long waiting list for surgery.

Mr Sunak said he would, but Mr Starmer said he wouldn't, adding, “I don't use private health. I use the NHS. That's where my wife works, in one of the big hospitals; as I said it runs through my DNA.”

Mr Sunak’s main line of attack throughout the debate was the Treasury-discredited claim of Labour plans raising £2,000 in taxes from individuals over the next Parliament. I think it is possible that this false £2,000 claim will open the door politically for Labour to hint at moving away from its fiscal hair-shirtism.

The need for extra spending across the whole of the public sector is going to be huge. I am not saying health should get it all, but there are some areas in desperate need. Like estates.

Capital investment delays leave England’s hospitals crumbling
Decade of austerity fuels record repair backlog in NHS estate, say doctors and policy experts

The Financial Times carried this depressingly accurate summary of the NHS capital and maintenance backlog, recounting one chief executive’s statement that “when it rains, we often have to stop surgery because theatres have flooded. Critical cancer operations are cancelled minutes before surgery because of leaks”.

Mr Sunak appears not to be able to buy a break this week: he laughed at the counter-heckle of a GP heckler at an event in his constituency.

Rishi Sunak laughs at GP joke as heckler says NHS is ‘disintegrating’
The prime minister is challenged over his policies during a campaign event in Wiltshire.

A GP and Conservative And Unionist Party member who started haranguing the PM about people seeing less-qualified staff in primary care was counter-heckled with the line “GPs spend more time on holiday than in the surgery, love”, at which Mr Sunak laughed.

It’s not tremendously obviously side-splitting, but then he has had a bit of a week.

Satisfaction with public services drops to new low

Satisfaction with UK public services sees sharp drop since 2021
Hospitals, train companies and police among areas with large decline, Ipsos/FT poll finds

The latest Ipsos/Financial Times survey on satisfaction with public services sees the sharpest drop in public satisfaction since the data taken from the end of the pandemic period in 2021.

Two-thirds of voters currently describe public services as “underfunded”, according to the poll. It also found that just 32 per cent of patients surveyed were satisfied with their local NHS hospital, compared with 80 per cent of people polled by the group in 1998.

Meanwhile, just 40 per cent of patients reported that they are satisfied with their GP, compared with 90 per cent in 1998.

57 per cent of responding self-identified Conservative voters attributed the decline in services to poor management: the Labour and Liberal Democrat supporters put the blame on the UK government policymaking, at 67 per cent and 60 per cent respectively.


Leak shows Leadson pitched new £10 a month charge for access to NHS dentistry

Exclusive: Minister proposed £10 monthly ‘insurance style’ fee for NHS dentistry
A health minister has suggested citizens could pay a monthly fee - similar to an insurance scheme - to be entitled to free NHS dentistry, at recent meetings about how to solve the crisis in the service, HSJ has learned.

When civil servants get really confident that a change of government is nigh, they start leaking some really interesting things. This happened this week, as HSJ’s Mimi Launder was briefed that health minister Andrea ‘Mother’ Leadsom proposed a new insurance-style £10 monthly charge for access to NHS dentistry.

Nor was it once: this happened across several round-table events held by the Department For Health But Social Care in April.

The big vote that really matters

I was wrong.

Yeah, I know. Again.

I thought that Mr Sunak would go full-term, and so we could have been treated to another Health Secretary in a post-locals reshuffle to re-establish his authority over his party and reward his ‘top people’.

Now that we have the 2024 General Election, we have been enabled to have the big vote that really matters. It is this one: who was the funniest Conservative And Unionist Party Health Secretary 2010-24?

We have a rich field from which to choose. It is surprisingly deep, given that this field contains Jeremy Hunt: the longest-serving Health Secretary (or indeed minister) in the history of the NHS, lasting 2012-18.

But we start with Andrew Lansley (Savour, Liberator). Put into post under the Coalition in 2010, Mr Lansley’s madcap plans in Equity And Excellence: Liberating The NHS aimed to turn choice, competition and clinical commissioning into the new NHS operating system.

Ahem. That worked well.

Perhaps best of all, he gave us the speech line I’m sorry if what I’m setting out to do hasn’t communicated itself. That happened, in The Real World.

The Lansley era was even more special with the work of #SimonBurns4SOS. A political Titan, whose leonine hair, being David Bowie’s cousin and frequent bellows of “NYE BEVAAAAN!” really enlivened the Bill Committee sessions and debates.

You don’t often got so memorable a health minister, alas.

The bonfire of the Conservative And Unionist Party’s political capital on the NHS (and indeed more broadly) involved in seeing these reforms through, via major surgery and the ‘pause’, to become the 2012 Health And Social Care Act traumatised Tory politicians and advisors on health reform for a generation.

It also led directly to PM David Cameron and Chancellor George Osborne begging Simon Stevens to come back from his lucrative job at UnitedHealth in the USA, and try to fix the NHS mess. Those two wholly unintended consequences were by far Mr Lansley’s biggest legacy.

So great was his disgrace that he was made Leader Of the House Of Commons, before being kicked upstairs to the Lords.

At the cost of huge political capital, a version of the Lansley reforms became law in the 2012 Health And Social Care Act. I argued that since the legislation had been passed, Mr Lansley should be left in place to see it through.

Funny old world. Jeremy Hunt was brought in, moved from Culture where he had become embroiled in the Murdoch/News Corp/phone hacking row. The initial aim was probably for Mr Hunt to ‘do a Johnson’ - not Boris, but Alan, by making health dull again. Success would be your news being a ‘news in brief’ item on page 13.

However, Mr Hunt’s first major task was responding to the Mid-Staffs Public Inquiry Report.

This led patient safety to become Mr Hunt’s big theme. There were intermittent enthusiasms for making the NHS digital and speeches about the next twenty years of the NHS, which thereafter seemed obligatory for his successors.

His major error was the fight with junior doctors 2015-16 over the new contract and the bizarre misassumption that junior doctors weren’t working at weekends. This was highly avoidable. But so poorly led were the JDs that Mr Hunt won without really having to try.

There was also the detente period of having to cope with the arrival of Simon Stevens as NHS England CE in 2014. They eventually found a way of working together: I summarised this being Stevens as SOS and JH as national director for patient safety. (Simon even sometimes turned up to Jeremy’s Monday morning ‘running the NHS’ meetings.)

These two’s eventual ability to work together was most clearly seen in the achievement of a significant funding boost for the NHS in 2018.

Mr Hunt had a pretty decent joke about “no longer being the most interesting Jeremy in British politics”, but probably the funniest thing he ever did was refusing to be sacked by Theresa May in her Cabinet reshuffle, and adding social care to his job title.

Then came a true megastar. Matt Hancock - The People’s Partridge. A big advocate of the NHS getting “massively tech-ed up” (which didn’t happen), and an even bigger advocate of Aloytius Parsadoust’s Babylon/GP At Hand (Mmmmmmm. That went well.)

It’s difficult to pick which of Alan’s many highlights sums him up best.

We were spoiled for choice, really.

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To the considerable surprise of absolutely nobody, The People’s Partridge set fire to his career.

He was replaced by Sajid ‘The Saj’ Javid, fairly fresh from being sacked as Chancellor by Dominic Cummings.

Was there vaunted tech enthusiasm and a very bad speech about the NHS’s next 20 years?

Dear reader, there was indeed.

We even got the priceless line that the NHS was “a Blockbuster service in an age of Netflix”. Theologians are going to still be debating this one for decades to come.

The Saj threw in the towel over Johnson B, and so we got The Banker Mark One - Steve Barclay. He’d been a Treasury Minister AND a Health Minister, you know.

The Banker gave us what remains almost certainly the worst speech by a Health Secretary, anywhere, ever.

Honestly, give up a bit of your life to watch it. It is just spectacularly shit and clueless.

And then the Conservative And Unionist party membership chose Liz Truss to become party leader, and thus Prime Minister.

They did that out loud. In The Real World.

Clearly, a spectacular political leader and Prime Minister (SHE WAS PRIME MINISTER!) would deliver a spectacular Health Secretary. And in this, as in so many other areas, Liz Truss did not disappoint.

Enter Dr Therese ‘Tiz’ Coffey. Whose talents were so manifestly huge that she did the job of Health Secretary as a jobshare with being Deputy Prime Minister.

I mean, you don’t want to hoard your real talent.

And how hard can being Secretary Of State For Health But Social Care be?

Dr Tiz’s big themes in the job?

Disliking Oxford Commas, and slinging her unused prescribed antibiotics around.

Alas, for some inexplicable reason or another, Liz Truss was outlasted by a lettuce in her tenure as PM. Politics can be so cruel.

And incoming unelected leader Rishi ‘The Brand’ Sunak chose Steve Barclay to do the job again.

It went just as well as the first time.

With the finely-honed political instincts of a killer gerbil, Rishi ‘The Brand’ Sunak rolled the dice and reshuffled once more, giving us the ostensibly sensible Victoria Atkins as this season’s last Conservative And Unionist Party health secretary.

Appearances can be mightily deceptive. It is hard to know whether it is down to Mrs Atkins or her SpAds, but a fondness for bizarre promotional films has marked her tenure in the job.

I encourage you to waste just under three minutes of your life watching this Department For Health But Social Care telenovela about Bob The Whippet making Mrs Atkins his emotional support human.

Mrs Atkins’ slogan in the job was about her aim to make the NHS ‘Faster, Fairer, Simpler’. FFS, for short.

A mighty field.

My obviously highly methodologically rigorous and statistically significant Kiss (formerly Twitter) poll got us down to a final two candidates.

But, like Highlander, there can be only one.

And the winner is …


The People’s Partridge. Matt Hancock beat Dr Tiz in the vote-off by as close to 52:48 as to make no difference.

Couldn’t have been any other way.

GMC: GPs not accountable for physician and anaesthetist associates’ actions

Desperate times call for desperate measures, and the General Medical Council’s chief executive Charlie Massey wrote to primary care to advise them that “our guidance for doctors is clear that, as with other professionals that they supervise and work alongside, doctors are not accountable for the decisions and actions of PAs and AAs, provided they have delegated responsibility to them in line with the standards and guidance in Good medical practiceLeadership and management for all doctors, and Delegation and referral

“When it comes to good supervision, there isn’t a one-size fits all approach because individuals who are being supervised develop their skills, competence, and experience over time.”

As Pulse’s coverage reports, this comes in the same week that a group representing anaesthetists of all grades announced it is taking legal action against the GMC, designed to achieve “clear and enforceable guidance” on the “privileges of members’ admitted to associate practice, defining what they can and cannot do”.

Oh, and it turns out that Faculty of Physician Associates President Jamie Saunders did have a vote in the Royal College of Physicians EGM ballot on scope and role of PAs, and only resigned his role after the voting closed.

RCP Council member Professor Partha Kar, who disclosed this, reported that he has had “no information whether the vote will be rerun or Mr Saunders’ vote declared void due to COI. A knife-edge vote on PA register - the RCP direction being decided potentially by a PA?”

Well, quite.

Ongoing Tory mega-donor TPP boss Frank Hester? Demonstrably racist? You don’t say.

New Frank Hester race claims pile pressure on Tories over £15m donations
Exclusive: Hester allegedly used term ‘token Muslim’, imitated people of Chinese descent and said a person was attractive for a black woman

Who could conceivably have predicted that misogynist racist and Tory mega-donor TPP boss Frank Hester would give the Conservative And Unionist Party a further £5 million and also be further reported to have been an enormous racist?

It’s just baffling.

The Guardian reports further accounts from TPP staff that Mr Hester “referred to a staff member as the “token Muslim”, imitated people of Chinese descent and remarked that one individual was attractive for a black woman”.

Mr Hester is clearly living in an episode of ‘Love Thy Neighbour’. He is the Alf Garnett of health tech.

Farage’s Reform call for more Europe

‘Reform’ party owner and neo-leader Mr Farage proposed this week that the NHS model should be replaced by a French-style social insurance system. And there we were thinking that Europe was the cause of all UK ills!

One must have a heart of stone not to laugh at demagogue buffoon Mr Farage’s efforts to sell changing the founding model of the NHS to UK voters - when years of polling evidence, including this very recent one by Ipsos for the Health Foundation, overwhelmingly shows that UK citizens don’t dislike or distrust the single-payer tax-funded NHS model - but do want it to work properly.

Shifting from a Beveridge-type health system to a Bismark-type one would likely, by itself, achieve little - except maybe a new sense of popular entitlement to better, faster care from a long-mismanaged and capital-starved system. That is likely to work out as well as Brexit has.

And speaking of the Voldemort issue of British politics, it might also be worth people’s while considering how that particular set of radical changes to the UK’s political and social system advocated by Mr Farage worked out in practice.

Observer piece on Barking, Havering and Redbridge’s rather more imitable-looking attempt to increase elective productivity and efficiency by use of a ‘cold site’ elective hub and improved organisation.

Well-informed FT piece on private providers making unjustifiably huge fees from public sector procurement contract management deals.

New Institute For Government report on the precarious state of the State.

Professor Partha Kar’s latest BMJ blog accurately outlines the sea-change in the clinical workforce is spot-on. There is a sea change among medics, and people who try to ignore it will get swept away.

FT reports new numbers for increased private healthcare use from the Private Health Information Network.

RIP media medic Dr Michael Mosley.