Cowper’s Cut 376: Living in “really retail” times with The 3:7 Forward View
It seems that the NHS in England will not undergo ‘Kibasification’, after all.
In a notable piece of karma, the Financial Times revealed that Tom Kibasi, who was brought in by Wes Streeting to sideline official 10-Year Plan directors Paul Corrigan and Sally Warren, is now himself being sidelined by Wes Streeting in favour of former IPPR health lead Chris Thomas, as the 10-Year Plan goes through further drafts.
Lucky Chris Thomas: he has become the new Wes’ whim of the week.
Why has this change been made?
The FT reports that ‘a senior figure in the health sector’ (who may or may not occupy the same pair of brogues as Alan Milburn) briefed them that the last full draft of the Ten-Year Forward View “was considered underwhelming. There’s nothing really retail in it. What’s going to be the big, headline-grabbing change that patients notice?”
Money can’t buy you appiness
‘Cut’ readers will be relieved to hear that the powers behind the throne of the Department For Health But Social Care who briefed the FT have gone all-in on the NHS app as The Great Solution.
Did the Matt Hancock app die in vain?
Apparently, their plans for developing the NHS app will include enhancing its functionality to allow the public to book and change doctors’ appointments, and receive automated advice about their symptoms. “We definitely see expansion of the app as a big part of the plan. It can be the great equaliser in healthcare.”
Right.
The FT also reports that “among areas of contention, according to two people familiar with discussions, is whether the acute hospitals sector should have a target for a share of overall health expenditure. The idea behind such a move would be to rebalance spending to direct more resources to primary and community care, one of the people said. The second said the plan might include only a softer statement of intent.”
The ‘triple shift’ (from treatment to prevention; from acute to community; from George to Ringo) is, as I have frequently written in these columns, going to be A Thing in which we can believe only once we see the funding flows within the English NHS follow its rhetoric.
HM Treasury
You can certainly argue that the decisions by Team Streeting to put the extra money into elective acute care and pay settlements, rather than into a big boost for primary care, was politically expedient and rational. I have often written that the Labour manifesto’s focus on returning to 18 weeks by the end of the Parliament means that this, above all else, is their NHS success metric.
In the words of Pierre Mendès France, “to govern is to choose”.
And if we follow the money, we can see that it is not going in the triple shift’s direction. A choice was made not to focus on the basics and stabilise the system: primary care would have been the right place to start.
That choice is unlikely to age gracefully.
Furthermore, the money is very, very tight. It is worth reading this piece from the Kings Fund, for its useful temperature-checks with local leaders on the financial realities currently in play.
Nanotechnology and surprise
It was with a nanotechnology level of surprise that the FT’s second major piece on NHS reform of the week confirmed that the next three years will be all about returning to 18 weeks RTT.
The FT team reports that The NHS Ten-Year Plan is now internally referred to as the “three-seven” plan: “the first three years are expected to prioritise clearing long waiting lists as well as building a foundation for wider changes”.
Well, well, well. The 3:7 Forward View. It sounds like a time-restricted eating weight loss plan (which in fiscal terms, it is).
The FT was told that The 3:7 Forward View plans may include “a bigger role for hospitals in running community services”, which would be quite something, given what we know about community services and about the imminent shrinking of ICBs’ system management roles.
Curiously, the FT was also told that since the Department For Health But Social Care’s work on The 3:7 Forward View began, “the financial outlook has changed significantly … now the primary focus is on recovering services in the next one-to-three years rather than the more transformative stuff [the government] had been planning”.
This is curious, because it is bollocks.
The UK government’s financial outlook has not changed significantly in the past year. Sure, economic growth has disappointed, which is a long-term trend. The second Trump administration has created economic uncertainty, which is very much its core point and way of working (President Trump is best understood as an economic gangster, working in the drag medium of politics).
Does it matter if DHBSC policymakers are talking bollocks?
What these FT pieces tell us about the state of the team behind The 3:7 Forward View probably is important. There is a tendency to dismiss this sort of thing as ‘Whitehall Village gossip’. It is, but it’s more than that.
The ‘Everything Everywhere All At Once’ theory of prioritisation that characterised the Amanda Pritchard regeneration of NHS England has clearly been in play with the ‘triple shift’ rhetoric. With no coherent economic and operational theory of change about how it would be delivered, an expectant English public will be waiting for some time yet for the shift from George to Ringo.
The churn of the personnel in charge of finishing The 3:7 Forward View matters because it shows inconsistent political leadership. Reports are emerging that Health But Social Care Secretary Wes Streeting is demanding much more detail in the already-150-page 3:7FV, and an easy-to-understand “retail offer”.
Ah, that word again. “Retail”. “Really retail”.
I’m not saying that retail analogies are the last refuge of a health policy idiot, except that I am, really.
Civil servants and NHS leaders are observing these inconsistencies from Team Streeting with rising interest, and I have been getting some golden feedback on the phrase ‘Wes’ whim of the week’.
There’s nothing like a Government that knows what it’s doing in health policy, and this is nothing like a Government that knows what it’s doing in health policy.
Recommended and required reading
The Commons Public Accounts Committee’s report on the Department For Health But Social Care’s Accounts 2023-24 highlights the huge costs of NHS clinical negligence: £58.2 billion has been set aside to cover the potential cost of clinical negligence events. The PAC report also says that the abolition of NHS England has been done with no real plan: it says that the Government “has still not set out how this major structural and operational change will impact key services and targets to improve patient care. Other areas where government was unable to provide clarity to the PAC’s inquiry include:
- The lack of a clear plan for how DHSC and NHSE will achieve significant headcount reductions, and the costs involved;
- How the reductions fit in with the wider 10 Year Health Plan for the NHS;
- How savings made from reducing NHSE staff costs help frontline services;
- How the institutional knowledge of NHSE would be preserved following its abolition;
- The scale of headcount reductions in the DHSC, and the geographical spread of the planned 50% headcount reductions in NHSE and across local Integrated Care Boards.”
But apart from that, it’s apparently going fine.
RTT total waits rose by almost 20,000 in the latest monthly data, after several months of total falls.
Health Service Journal reports that the new very senior managers (VSM) pay framework means that VSMs at the worst-performing trusts and ICBs will no longer receive annual pay rises.
Financial Times coverage of an initiative between clinics to improve frailty care.
The Guardian’s David Conn has this in-depth piece on the safety of Lucy Letby’s convictions.
Intriguing Guardian article on ‘inverse vaccines’ for autoimmune diseases.
The FT reports with a straight face on the Trump administration’s plans to cut pharmaceutical prices in the USA: “almost immediately by 30 per cent to 80 per cent”. NICE work, if you can get it.
The Sunday Times looks at a possible backlash to the KKR bid for Assura, with Primary Health Properties increasing their offer.
Times speculation on the result of yet-to-be-confirmed pay rises.