Cowper’s Cut 374: Un-amazing us with Wes’ whim of the week
“Etonne-moi!” was the famous phrase used by the Russian ballet innovator Serge Diaghilev. It means “amaze me”, and the past week has seen several bits of national NHS policy news that do quite the opposite.
Dave West
The first prize goes to the news, reported by the estimable Dave West of Health Service Journal, that the abolition/Borg-like absorption of NHS England into the Department For Health But Social Care will not be done quickly. In other news just in, employment law still exists, regardless of Health Secretary Wes Streeting’s whim of the week.
Dave also reports that “NHSE and DHSC have also so far failed to recruit a national transition director to oversee the merger. They had hoped to quickly bring in a senior and experienced manager, but discussions with at least one potential recruit have fallen through”. The sheer ingratitude.
The biggest poisoned chalice in UK public policy
It’s a terrible sign of the state of things that absolutely nobody wants to volunteer to down-in-one the biggest poisoned chalice in UK public policy. Where’s your ambition?
Passing up this opportunity to be hated by most of your colleagues, and then blamed by the politicians for the merger/abolition/Borging’s inevitable over-promising and under-delivering, is just shocking.
Surely nobody could have thought that ‘opportunity’ to be in The Real World a problem that is (in Comrade Sir David Nicholson’s wonderful phrase) “so large you could see it from space”.
But Wes wants it, chaps! (Despite having not wanted it all the way back in January.) So get with the programme, Daddie-o!
Until the programme changes again, based on Wes’ next whim of the week.
Which 2002-era Strategic Health Authority are we?
Dave West
The next un-amazing bit was also one of Dave’s stories: this timely analysis of the runes about the restructuring of Integrated Care Boards - which is in no way going to take us back to the 2002 future of merged strategic health authorities. This Nuffield Trust piece by Nigel Edwards and Helen Buckingham is again timely on the subject of the intermediate tier.
Dave’s analysis “suggests the greatest change will come in the Midlands region, where 11 ICBs are likely to reduce to five or six, the South West (from seven to three), and the East (six to two or three). The greatest uncertainty appears to be in the south region, while relatively little change is expected in the North East and Yorkshire, North West, and London regions”.
Now to some extent, caring about the shape of the English NHS intermediate management tier marks you out as a truly special person. Happily, we here are all such special people, and in that spirit, I suspect that we also all know that it is as important a matter as the national system leadership lets it be.
If legislative fiat were genuinely important, then former NHSE boss Simon Stevens would not have been able to subvert the shit out of the Lansley reforms. But he was able to do so.
Clearly, Simon is no longer around NHSE, and many people have been quite happy about that. But politically, his leadership is having a big Banquo’s ghost moment. Because Stevens gave us proof of the concept that if you know what you are aiming to achieve and you can make the political weather with some subtlety and skill, then you don’t need to worry about anything as vulgar as what the actual law passed by Parliament says.
The same political reality applies to ICBs, SHAs and whatever other intermediate tier of NHS management you may care to name. If there is solid national system leadership moving towards a pretty well-defined goal, then actual constitutional, legal and organisational forms do not have to be important at all.
So, how are we doing on the ‘solid national system leadership moving towards a pretty well-defined goal’ front?
Mmmmmmm. If not mmmmmmmmmmmmmmmm.
Another Banquo’s ghost has been the national leadership of the original NHSE boss, Comrade Sir David Nicholson. His interventions about considering NHS 10-Year Plan implementation and about ICBs’ needing to merge are looking highly prescient.
Social care review TORDIS: smaller on the inside than on the outside
Department of Health and Social Care
Baroness Louise Casey’s social care review this week published its terms of reference to distract, or TORDIS. Unlike the TARDIS, this is smaller on the inside than on the outside, as it is tasked to “produce tangible, pragmatic recommendations that can be implemented in a phased way over a decade” in its phase one medium-term remit, culminating in a report by 2026.
This implies that whatever “tangible, pragmatic” (read “affordable”) changes it recommends to social care, they will not be coming into widespread effect until 2036.
Yes, 2036! Andrew Dilnot might be dead by then.
We really do seem remarkably determined to keep the tradition of a knackered NHS alive and kicking.
Recommended and required reading
Good HSJ piece on what promises to again become the topical issue of NHS staff pay from Anita Charlsworth of the Health Foundation’s REAL Centre.
That doyen of journalistic high standards Guardian health policy editor Denis Campbell has run this press release for the new cancer report from Mike Birtwistle’s Incisive Health, which is certainly good for Mike.