Cowper’s Cut 393: English health policy enters its Skibidi Era
Writing accurately about English health policy and politics isn’t easy.
Probably, nor should it be. The English NHS is a complex adaptive system: one shot through by humanity and politicisation, and fear and need.
Were anyone who works in this area to try and quantify the amount of unconditional trust that a sensible person might invest into either humanity or politicisation (let alone into fear and need), the result might make that author/analyst seem even more misanthropic than usual.
In the words of the great Kurt Vonnegut, “so it goes”.
Longstanding readers may have noticed that while I’ve been unimpressed by the new Government’s endeavours in this area of the English NHS, I’m also yet to articulate why everything seems to be quite as very shit as it currently does.
Here goes: the utter dysfunction of the previous ‘Woman In Black’ Era leadership of NHS England has combined with the incoming political administration’s utter lack of meaningful analysis and original thought about why the English NHS is in the depth and breadth of shit that it currently is, to create a genuinely new environment.
The English NHS has entered its Skibidi Era.
Contributors to Wikimedia projects
“What is a ‘Gazza’?”
My fellow old people may need some translation here: Skibidi is A Young People’s Online Thing, which “follows a war between toilets with human heads coming out of their bowls, and humanoid characters with electronic devices for heads”.
(Yes, I know: it does sound like they’ve discovered the perfect metaphor for NHS England.
(Let alone their wanting to make you put your children’s psychoanalysts on danger money.)
Skibidi is young people’s speak for telling others, ‘we can see in broad terms what you’re aiming to be doing, but it makes absolutely no fucking sense whatsoever to us - so here’s some surreal satire of it all instead.’
That’s the reality of where we are in English health policy, in September 2025.
It is clearly by no means a niche opinion that the NHS Ten-Year Plan is, as I described it, a ‘specious hallucination’. A mere two months after its publication, the NHS10YP feels like an ancient artefact (save to its few brown-nosing stans, such as “positivity and optimism” acolyte Daniel Elkeles of NHS Providers).
So within just sixty days, the NHS10YP has already become an historical document, without ever having been a relevant one.
Funny old world.
The Skibiditude of the immediately-past NHS England leadership was on vivid display as the new top team at NHSE/DHSC went in front of the Commons Public Affairs Committee, and effectively repeatedly admitted that alleged plans by the Pritchard administration to cut zillions of NHS outpatient appointments had been made without any meaningful clinical consultation.
Any viewers who are also members of the brain-owning community would rightly have been hoping that ex-NHSE clinical director Professor Steve Powis would have been watching this section of the session with acute embarrassment - which, of course, he almost certainly wasn’t. (He may not even have been watching it with several cute embarrassments.)
There are some people whom it’s just impossible to embarrass. Milburn bless them, each and every one.
We’re living through a moment when there is no agreed extra money for the redundancies inevitably to be created by shutting down NHS England and halving ICBs’ budgets.
Unsurprisingly, senior figures in the English NHS who perceive themselves as being hung out to dry, such as NHSE’s freshly-resigned national director for mental health Claire Murdoch, are quitting in spectacularly public style (and indeed, doing so with a high-profile NHS chief executive job to return to, in Claire’s case).
Claire’s resignation letter to NHS England’s pro tem boss Sir James Mackey, leaked in full to Health Service Journal, observed that “it seems that it is common knowledge that change at the top is wanted. You have told me that a new person to lead the sector is wanted by our political leadership, and I have no doubt that there are many talented and committed people from which to choose.
“Since this position is apparently widely already known by several people I cannot continue to do the job in the way it deserves to be done - and it’s best that you quickly find someone that you and the political leadership can have confidence in.”
Ms Murdoch’s letter also raises concerns about mental health spending and described maintaining its share of NHS funding as “critical”. She said it “… fell last year, and will again this year. It likely will continue to do so over the next 3 years. I hope I am wrong.”
It’s instructive to read the below-the-line comments on the HSJ story from the few brave individuals who put their names to words of commendation and thanks for Claire’s nine-year stint in this national role.
It’s equally instructive that no ministers had the guts to put their names to the DHBSC’s dismissive comment for the HSJ news story.
I do not need to tell ‘Cut’ readers that this is not the right way to get rid of a national director of a key service.
You can reasonably agree or disagree with aspects of Claire’s approach to the job - but if there are serious faults to be found with a national director, then here’s what you do: you find those serious faults, and then you prove them to a balance-of-probability standard.
And then having done so, you publicly dismiss the errant national director, in part ‘pour encourager les autres’.
Because you as the national system leader need a) to be demonstrably in charge, and b) to demonstrably be doing the right things.
Team Streeting have not done any of this, preferring to do their thing against Claire via rumour and briefing.
Skibidi Streeting
This is a Skibidi approach to being Health Secretary.
It makes Wes Streeting the NHS’s first Skibidi Health Secretary: something which is not really a badge of honour.
That’s not an accusation that anyone should make lightly, were it not for the fact that Young Mr Streeting likes to walk onto trouble with the chin-first insouciant air of a true Skibidi.
Andrew Gregory
Streeting’s comments to this weekend’s BMA special meeting about the potential impact of Reform if they get elected in 2029 are heroically vacant of thought about what (and indeed how) a Labour Government with a majority of over 150 can achieve in and on the English NHS between now and 2029.
Calling for the BMA to become “friends, not foes” of the Labour Government, an apparently historically illiterate SOS Streeting bid that “the alternative is (that) strikes continue to hold back the NHS’s recovery; the costs of industrial action slow down investment in new technology, equipment and additional specialty places; the changes that we all agree need to be made are blocked, and patients continue to be failed …
“From there, the public will conclude that Labour has failed on the NHS, and they will elect a Reform government instead – a party that has openly said it will replace the NHS with an insurance-based system.
“That’s the consequence if we fail.
“That’s the stakes that I’m dealing in, and don’t be under any illusions. I think you know perhaps better than I do because you work in it.
“The NHS is hanging by a thread. So I urge the BMA not to pull on it.
“ … The government has changed. The attitude to the NHS and its staff has changed. I need the approach of the BMA to change too. Rescuing the NHS from the biggest crisis in its history is a team effort and it will only happen if we are on the same side, working together.
“I can’t do this alone. I need partners, not adversaries … If we fail and Nigel Farage gets his hands on it, then it is Reform and die. I don’t know about you but I do not want that on my conscience.”
This isn’t necessarily the line that someone serious would use, in the same week when English NHS RTT waiting lists had started rising again, despite major efforts and well-funded waiting list validation (which of course had been under way anyway … right?).
No more impressive was Mr Streeting’s article arguing against NHS strikes for The Times.
Towards a Milburn-led NHS
Among the problems that are now vastly clear with our sophomore Skibidi SOS Streeting, one of the most obvious is his tendency towards being an Alan Milburn tribute act.
Longstanding readers may recall my having mentioned this parochial political predilection once or twice previously.
Mr Streeting listens to the counsel of his own ego, and to that of Mr Alan Milburn. (The two are not yet wholly the same, but who knows the future? This administration is still young, and not even Mystic Meg predicted her own downfall.)
It is not merely a common critique for Mr Streeting that he does not listen to other people: it is as close to universal as makes no meaningful difference.
However, as a Utopian Fundamentalist, I am always at hand to help with the improvement of English health policy.
As such, I have realised how the world of health think-tanks and representative bodies can effectively and efficiently get their points across to SOS Skibidi Streeting.
It is simple: they just need to rebrand themselves as ‘Alan Milburn’.
The deed poll form for individuals is here: companies, charities and suchlike will have to consult their lawyers.
But it will all be worthwhile, however much it may cost administratively.
Because we all know that the one person to whom Mr Streeting listens is Alan Milburn.
So let us simply expand the available range of Alan Milburns.
I look forward to a new golden age of the rule of lore of the NHS Confed Alan Milburn; the Kings Fund Alan Milburn; the EveryGrifter Alan Milburn; and many, many other and uniquely special Alan Milburns.
Competition in action, private sector-style, innit? Alan Milburn would surely approve.
Polyclinics? Again? So soon? Did Darzi Centres die in vain?
The Department For Health But Social Care has begun sniffing around private investors to build the late 2020s version of Darzi Centres (AKA polyclinics), as Gill Plummer, infrastructure correspondent of the Financial Times, has learned. She reports that what’s in scope may be up to “200 neighbourhood health centres, in a move that could transform NHS care in England but threatens to reignite a fierce debate over the funding model.
“Investors would win long-term contracts to design, build and manage local NHS centres with the aim of having one in every community by 2035 and the most deprived areas targeted first … with construction costs ranging from £10 million to £40 million per facility using a ‘standardised design’.
“ … (DHBSC) is being advised by management consultancy Deloitte and law firm Addleshaw Goddard, and working with the new National Infrastructure and Service Transformation Authority. The public sector would provide the land while private companies deliver the facilities and services on contracts of between 25 and 30 years, the documents noted.
“One private provider would be expected to deliver “several batched lots”, they added, while health clinic services would be delivered by a single public sector organisation, which would charge tenants and manage the use of the space.”
Plimmer has covered the messy ending of NHS hospital PFI contracts for the FT for some years, as longstanding readers know. She notes that a final decision on whether to go ahead with these privately-financed Darzi Centres is expected in the Budget on November 26.
I have written about the likely return of PFI again and again and again. As others have.
The Treasury lock and key on such events, given that they are inevitably and irroevocably on the UK Gov balance sheet, is going to slow this down considerably.
Half-a-league table, half-a-league table, half-a-league table onward
In an Alan Milburn nostalgia NHS era such as ours, it’s unsurprising that the league table approach to measuring NHS provider performance is back.
Mid Staffordshire NHS Foundation Trust Public Inquiry 2013
It’s almost as if there were a demonstrably good reason why the NHS in England abolished league tables.
Recommended and required reading
New analysis by the Royal College of GPs finds that one in seven GP practices in the English NHS have shut since 2018. There are now 6,229 active GP practices.
The FT’s Sarah Neville interviews the UK’s first clinical professor of AI in radiation oncology at the University of Cambridge.
For a laugh, have a look at this piece by the Boris Johnson Fanzine, which simply repeats ABPI press release talking points wholesale.