Cowper’s Cut 396: Buying time for Wes Streeting’s Imaginary NHS Friend
It’s hard to see what the Government’s NHS theory of change is. This may be because they haven’t got one.
Since their election, we promptly had the effective blamestorming of the Darzi Review II (This Time, It’s Personal).
Less promptly, we also had a farewell to arms’ length, as NHS England was possibly put out of its misery; followed belatedly and multi-authorally by this summer’s specious hallucination of the NHS Ten-Year Plan.
Lucky us.
The NHS Ten-Year Plan came to us courtesy of Wes Streeting’s eminence grise Alan Milburn, whose mantra (as disclosed to Nick Timmins for The Health Foundation’s ‘Glaziers And Windowbreakers’ book) is that “the best political trick I ever pulled off was to publish a 10-year plan. Why? Because it basically bought time.”
It is not without reason that I suggest English health policy and politics has entered its Skibidi Era. We have no idea how the triple shift and the neighbourhood health service are meant to be delivered.
New Labour Nostalgia
On top of the Skibidi, we seem to be living in a New Labour Nostalgia Era. Oasis had their comeback, so fair enough, possibly.
If New Labour Nostalgia is the vibe, then perhaps it’s just too soon. Just as 2000’s The NHS Plan set reform ambitions via targets, spending and staffing commitments, but the actual delivery mechanisms of an inspectorate, tariffs, FT status and funding flows only arrived in 2002’s Delivering The NHS Plan, arriving in the wake of the Wanless Review for HM Treasury (this Parliamentary briefing remains a good read on both).
If that is the template, then presumably we have to wait until summer 2027 to get our guidance in ‘The NHS Ten-Year Plan: How To Do It’.
Given that the next General Election must be held in 2029, we’ll hope that is not the intention. These are angry, impatient and volatile political times.
However, we might equally hope that the Department For Health But Social Care’s leadership wouldn’t announce huge redundancies in NHS regional and national administrative bodies without any budget to fund them. Or that there would still be no clear plan for publishing a NHS10YP delivery plan, or that the whole restructuring/redundancy thing were starting to look like it’s being put on hold.
Ah well: you can’t always get what you hope for.
And hope is not a plan.
For the time being, NHS England’s interim leader Sir James Mackey is fronting an effective national campaign for financial balance at all costs. Everybody is perfectly clear that this (and this above all else) is the service’s marching orders.
And it is not wrong: regaining reliable financial control of the English NHS is necessary, but not sufficient.
Not 2001: A Specious Odyssey
Indeed, as Health Service Journal reported, Department For Health But Social Care second permanent secretary Tom Riordan this week told a Health Innovation Network meeting that New Labour Nostalgia has its limits: “Alan Milburn is, as you’ll know, an amazing, talented former secretary of state, a really wise, experienced voice. [His] greatest hits are coming out at the moment – the league tables, the performance and oversight, the singularity of being really clear about what you want from people in terms of electives and GP access, and [urgent and emergency care] performance and money.
“(That’s) really, really important; that’s fine, but it’s not 2001. We’ve had austerity, we’ve had covid, we’ve had Brexit, we’ve had all these changes – it’s a different … more complex world now. How do we help make systems be able to do those things without it feeling like … people are having to operate in splendid isolation to achieve them?”
“If you look behind all those targets, then the key to them is not the [actions of the] NHS and the big acute trust operating on its own. Of course some of it is, and [trusts have] got to be really, really good at that.
“But a lot of it is how we connect with people much better, [how] we have human-centred approaches to public services [and] we think about that in terms of where people live and where they work.”
This is a welcome sign of actual thinking about current realities. And it marks a stark contrast to the prevailing sense that national policy is being idiosyncratically made up as Team Streeting goes along.
Or put another way, that the NHS Ten-Year Plan is a means of buying time for Wes Streeting’s Imaginary NHS Friend to come along and do all the hard stuff to just make everything happen. Action this decade!
The unseriousness of recent approaches to management was revealed this week by Sarah Neville’s FT piece prompted by FOI data obtained by the UCL Global Business School for Health, showing that that “on average, just £106 a year was spent on training for every senior NHS manager over the past five financial years. Only one in five NHS leaders received senior management training over the past five years”.
Labour conference promises NHS Online
The big health announcement of the Labour Party conference this week was given to PM Sir Keir Starmer in his speech: “NHS Online, a completely digital NHS trust”. There is plenty to wonder about how this will be delivered: the business model; the access arrangements; the tech’s compatibility with the NHS’s most significant user communities of the long-term comorbid and the frail elderly. But it is an innovation, and it builds on existing good (and presumably safe) practice. So it’s a positive step.
SOS Streeting’s speech was well-delivered (as one expects), and was remarkably popular in the hall - particularly the early full-on attack on Nigel Farage and Reform’s Malhotra-platforming. Delegates also loved the tactical section about Angela Rayner and how “we want her back”.
Mr Streeting had some rather good lines, such as those outlining how “we are reforming general practice, so patients can request appointments online at any point during the day. Many GPs already offer this service, because they’ve changed with the times. Why shouldn’t booking a GP appointment be as easy as booking a delivery, a taxi or a takeaway? And our policy comes alongside £1 billion extra funding for general practice and 2,000 extra GPs.
“Yet the BMA threaten to oppose it. In 2025.
“Well, I give you this warning. If we give into the forces of conservatism, they will turn the NHS into a museum of 20th century healthcare. We will always stand up for the interests of patients and we won’t back down.”
This is stirring stuff, although there are obvious reasons why booking a GP appointment shouldn’t be as easy as booking a delivery, a taxi or a takeaway: the imbalance between supply and demand.
He also vowed that “as long as I hold this office, it will be the business of this government to build a National Care Service worthy of the name … as we rebuild the NHS, we are starting first where the need is greatest.
“As we reinvest billions saved from cutting waste, as we recruit new GPs, and as we build a new generation of Neighbourhood Health Centres, they won’t go to the places with the loudest lobbyists, but to the communities with the deepest deprivation.”
It’s good that Team Streeting have discovered Julian Tudor Hart’s 1971 Lancet piece on the Inverse Care Law, but remedying it does sounds expensive: particularly the business of getting people to go and base themselves for work in the poorest and most deprived communities.
A-haaa! He’s back!
What a privilege to welcome Matt Hancock back to our screens … oh.
But everybody’s favourite pub-landlord-contract-arranging TikToker crossed our radar again this week, with this bathos-drenched piece on Alan’s return to his family’s direct marketing business and the revival of direct mail. A-haaa.
The interviewer reports (apparently straight-faced) that “Hancock insists that his political career is behind him”. No shit.
What’s the world coming to, when a former Conservative And Unionist Party Cabinet minister can’t even be gifted a handful of lucrative sinecure NED roles?
Recommended and required reading
The Guardian’s David Conn is a proper journalist, whose work was crucial on exposing the PPE Medpro scandal: here is his report on the Government’s successful court case against the Noble Baroness Mone-associated company’s wrongdoing. They won’t get the money back, of course.
Good wishes to health minister Ashley Dalton, who has made public her diagnosis of incurable metastatic breast cancer.
A big week for medical malpractice news: consultant gynaecologist Daniel Hay; this Times co-investigation showing that 22 medical professionals subject to restrictions overseas have no record of any sanctions on their GMC licences; and over-confident and under-skilled cardiac surgeon Karen Booth, about whose practice colleagues at the Freeman hospital in Newcastle raised serious concerns in 2018 but no formal investigation began until 2021: NHS England interim boss Sir James Mackey backed Ms Booth for retraining, after having been in post in Newcastle for 14 months.
Good HSJ tribute to Matthew Hopkins, who is leaving Mid-South-Essex FT next month after having worked as chief executive of several seriously challenged trusts.
Shaun Lintern’s Sunday Times piece reveals that Public Health England and NHS England leaders knew in 2014 that there were serious problems in children’s audiology testing.
HSJ editor Alastair McLellan on where he sees the administrative landscape going in the coming couple of years.
The BMA’s GP committee leadership has threatened industrial action over the prospect of online appointment bookings.
Steve Black’s latest ‘Mythbuster’ column for HSJ deals with the mess of NHS data and how AI won’t fix it.
HSJ’s Dave West reports that the loss-making NHS Confed and the loss-making NHS Providers are to merge.
Interesting FT piece on start-up LinkGevity, whose product takes aim at ageing with drug to block cell death.