Cowper’s Cut 392: Exit Music
Lyons made for the exit
This week started so well for Sir Keir Starmer’s 10 Downing Street operation that the PM was already reshuffling the deckchairs to set the stage for an autumn that will include a difficult Budget.
The Guardian reported that “James Lyons, Downing Street’s director of communications for strategy, is stepping down” as part of the changes. James Lyons is best known to ‘Cut’ readers for his acerbic and incisive approach as deputy director and then director of communications for NHS England.
Lyons was reported as telling Downing Street and Whitehall colleagues, “when I came back from the summer break I told colleagues I was looking to leave by the end of the year. I’ve brought this forward to be part of the other changes.”
Mmmmmm.
In a masterpiece of understatement, The Times’ Patrick Maguire noted that “Lyons, out as director of strategic communications after 11 months, had not intended to stay for the long haul. But some cabinet ministers and special advisers were alienated by his forthright style”.
Lyons’ departure comes shortly after the redeployment of fellow former NHS England chief of staff and senior player Nin Pandit into a policy role. This moving of Ms Pandit (initially and wrongly described in the national media as a sacking) was accompanied by anonymous briefings against her on the grounds of lacking effectiveness: allegations inconsistent with her considerable reputation in NHSE.
Still, briefers gonna brief. The 10 Downing Street comms operation is now to be led by Tim Allan, a former deputy press secretary under Tony Blair’s PMship.
Taylor made for the exit
Personnel changes were quite the theme this week, with NHS Confederation chief executive Matthew Taylor pre-announcing his departure next April.
As I’ve previously written, there are strong suggestions that Mr Taylor has been asked to join the Department For Health But Social Care in a yet-to-be-defined capacity. This would be totally coherent with the dominant ‘getting the New Labour band back together’ vibe.
Eight months is a strange length of lead time for an exit. It is also telling that the statement of departure made no reference to the proposed merger between the Confed and NHS Providers. Together with the statement’s reference to the NHS Confederation's Board of Trustees meeting in October to consider succession planning, this may not please brown-nosing Daniel Elkeles, NHS Providers chief executive.
His departure statement claimed that “we have reasserted the role of the NHS Confederation as a constructive and influential voice in shaping health policy and practice on behalf of our members, while also empowering local health and care organisations to innovate and collaborate for the benefit of their local communities”.
It’s hard to justify this claim. The first three years of Mr Taylor’s tenure were under the Conservative governments of PMs Johnson, Truss and Sunak: to assert that the NHS Confederation (or indeed any health representative organisation or think-tank) had an influential voice during that period is not correct.
Under Sir Keir Starmer’s Labour, the Confed has become notably more productive of warm words; and Mr Taylor has certainly been involved more in advising Team Streeting on policymaking.
But influential?
Since last year’s General Election brought Labour in to power with a huge majority, the dominant influence on Labour’s English health policy by a mighty margin is former Labour Health Secretary turned management consultant Alan Milburn. This is why we ended up with the tech-fetishising NHS Ten-Year Plan landing with absolutely nothing about how it is to be delivered.
It’s very evident that Health Secretary Wes Streeting enjoys working with Mr Taylor, but that does not necessarily mean that the Confed’s role as an independent voice for the sector has been uppermost.
It’d be interesting to hear what NHS Confederation members in the Integrated Care Boards think of the assertion that their imminent economic vivisection demonstrates Mr Taylor’s and the Confed’s influence. The departure statement references “the legal establishment of Integrated Care Boards” as part of Mr Taylor’s achievements: this is curious, as it was almost entirely there in the 2019 plans NHS England’s former chief executive Simon Stevens was asked to draw up for the then-government of Boris Johnson.
More broadly, it seems surprising to suggest that the huge recentralisation of power in the DHBSC now under way was something for which the Confed or Mr Taylor had lobbied.
Unless I missed something?
The Rayner reshuffle leaves Streeting as SOS
Deputy PM, Housing Secretary and deputy leader of the Labour Party Angela Rayner resigned from all three of her roles this week, after investigation found her to have breached the ministerial code over stamp duty underpayment.
The impact of Angexit pushed PM Sir Keir Starmer into an unplanned Cabinet reshuffle. Sam Freedman’s analysis of the political and operational impact of this is worth reading.
It’s perhaps unsurprising that the PM left Wes Streeting in charge of the Department For Health But Social Care. Stephen Kinnock and Karin Smyth both retain their ministerial briefs: Mr Streeting’s PPS Dr Zubir Ahmed MP is appointed a Parliamentary Under-Secretary of State.
This status quo maintenance tends to indicate that real concerns in the health sector about English NHS reform plans are not much on the Downing Street radar. Changing the DHBSC’s leadership would have been a striking move, just two months after the launch of the underwhelming NHS Ten-Year Plan.
It’s hard to disaggregate the specific cocktail of anger and fear over pending as-yet-unspecified NHS management job losses from broader ambient discontent with the Health Secretary. A phrase that’s doing the rounds at present is “even Matt Hancock didn’t …”; followed by the speaker’s issues about the absence of funding for redundancies / neighbourhoods / capital.
There are also many people trying exceptionally hard to be on Team Streeting, hoping to secure their positions during the oncoming storm waves of management redisorganisation.
And whether due to economic uncertainty or vastly improved people management, the natural turnover rate of staff has slowed significantly: as Henry Anderson notes, in Health Service Journal, this will threaten savings plans based on not recruiting to replace leavers.
Henry and his HSJ colleague Nick Kituno also report that NHS England is facing a £300 million cost from the recent five-day resident doctors’ strike, and ministers have ordered a ‘spending freeze’.
It still feels as if (as I wrote last week) we are in the ‘phony-war’ stage of NHS reform. And those observing the politics of all this also had the unedifying spectacle of The Nigel Farage Party, also known as Reform, holding its conference in Birmingham this week.
Former nurse and former Conservative Health Minister Nadine Dorries was the star Conservative defector announced by Mr Farage. From the conference’s main stage, Ms Dorries gave a lecture about the importance of loyalty in a political party, which will have made a wry smile play around many people’s features.
This was not, however, the most ridiculous statement made on Reform’s main conference stage. Not by a long way.
Ben Quinn
To demonstrate their absolute seriousness and readiness to become a party of national government, Reform gave a main stage speaking slot to cardiologist and conspiracy theorist Aseem Malhotra.
Malhotra told the Reform attendees that vaccines “created havoc” in the human body (yes, this is indeed how immunisation works); but even more impressively, claimed to have been asked to share something by a doctor whom Malhotra described as one of Britain’s most eminent oncologists - but did not name.
“He thinks it’s highly likely that the Covid vaccines have been a factor, a significant factor in the cancer of members of the royal family,” said Malhotra, who had previously said, “This isn’t just his opinion many other doctors feel the same way”.
Mmmmmmm. And are these imaginary medics in the room with us now, Aseem?
NHSE board changes
NHS England
NHS England’s non-executive directors had a clear-out of Conservative era appointees, with ex-Monitor boss and Synnovis chair Dr David Bennett, NESTA chief executive and Behavioural Insights Team co-founder Ravi Gurumurthy and Bromley-By-Bow Centre GP Dr Sam Everington probably the best picks of the replacements.
Paul Corrigan and Louise Ansari also get their sinecures.
More medical strikes on the way?
Doctors represented by the BMA voted in support of industrial action in an indicative ballot. Sixty-seven per cent of consultants who took part in the ballot and 82 per cent of SAS doctors voted in favour of the principle of industrial action.
The Department For Health But Social Care response noted that consultant turnout was under 45 per cent, adding,“we’re grateful to every senior medic who has chosen NHS recovery over the BMA’s attempt to spark further unnecessary strikes”.
Recommended and required reading
The Financial Times spotted the Larry Ellison Technology Institute (he of Oracle) giving money not for once to the handily-AI-hyping Tony Blair Institute, but to the Oxford Vaccine Group’s five-year project. The group will use the funding for “human challenge” trials (where participants are deliberately infected under controlled conditions) to improve our understanding of how the immune system responds to bacteria that antibiotics sometimes fail to treat.
“The way to do reform effectively is to start by asking what you want to accomplish and what systems will best achieve that. If cost control is your aim, then what you need is not reform but to change who pays for something or for what. Governments need to put aside magical thinking and embrace difficult thinking instead.” Challenging and useful piece on public sector reform from the FT’s Stephen Bush.
It’s an FT-heavy R&RR this week: a fascinating piece about radioligand therapy, a new type of targeted radiotherapy.
More eventual good news on cancer treatment, via The Economist.
Latest issue of NHS England’s ‘The Month’.