Cowper’s Cut 408: NFA
There have been no hugely significant developments in English health policy and politics this past couple of weeks, so I’m not going to insult our intelligence by pretending otherwise.
The health secretary as absentee landlord
Two things were perhaps worth brief comment: the comments by nominal Health But Social Care Secretary Wes Streeting on the unlistenably-bad BBC Radio 4 ‘Today’ programme on the English NHS midwifery scandals; and this hopeless piece of brown-nosing dragged up as a comment piece for Health Service Journal by NHS Providers boss Daniel Elkeles.
Mr Streeting told ‘Today’ that as regards waiting for the outcome of the review that he’d ordered in July 2025, “in some ways that’s the problem. With 700 recommendations, my observation of the NHS and conversations I’ve had both with NHS leaders and with front-line staff, I think they can’t see the wood for the trees.
“And the NHS is almost drowning in recommendations. It’s not clear what is a priority, what isn’t: we’ve seen some perverse unintended consequences.”
Ahem. If a system is unclear about what is or is not a priority, it can only be said to be a failure of leadership.
Young Master Wesley continued, “the big criticism that this investigation has received, particularly from some of the maternity families, is what about justice, what about accountability, what about the need for a public inquiry?
“With enormous respect for these families and what they have been through … a public inquiry takes years. I don’t think we’ve got time to wait to crack on with maternity improvements.”
Young Master Wesley added that his “immediate priority” was to ensure maternity services were improving both in the present and in the future, and insisted that he was “genuinely open-minded” about whether to hold a public inquiry but said it would end up costing millions of pounds and could be an ordeal in itself for families.
The problems in UK midwifery are neither recent nor complicated. A huge part of them is the chosen cultural isolationism of much of midwifery from obstetrics, driven in large part by the cult of natural birth at all costs (the costs being largely those to pregnant women and their babies); and by a cohort of significantly older and fatter mothers.
Indeed as serial maternity inquiry leader Donna Ockenden told the ‘Today’ programme on Friday, “I can see exactly where he (Young Master Wesley)'s coming from, but I think that there are key issues that have needed resolution in maternity services for years now.
“They are workforce, they are training, they are funding, education and culture. That hasn't changed, I don't think, since at least 2010 - and had we acted on those areas when we should have, then I think we would be in a much better state now”. No shit.
(It was a delight to watch the Guardian’s ersatz fit of the vapours on discovering that Donna Ockenden has to be paid for the grim and laborious work that she does on the inquiries: experienced professional in ‘needs to be paid’ shock. There you go: fixed the headline.)
Young Master Wesley’s hand-waving is the conduct of an absentee landlord of a health secretary.
Brown Nose Dan’s reasons to be cheerful
As to Brown Nose Dan, in true Milburnian style he opens a piece that is inevitably about “the challenges and concerns that NHS leaders will have to tackle in 2026” while in true Wilkins Micawber / Pollyanna style, hinting at “the opportunities there for the taking”.
Wonderful! What, pray, Mr Elkeles, are these opportunities?
Principally, it seems to be “to let staff receive part of pension contributions as pay, if they want to” to resolve the resident doctors’ industrial action. I mean, maybe. Although the current generation of resident doctors seem very fond of money, and might be numerate enough to know that if they go down that route, more now means less later.
What else? For BND, “the most powerful evidence for optimism lies in the extraordinary ideas and innovation I see on visits to hospital, mental health, community and ambulance services”.
Aha. Does Mr Elkeles tell us what these extraordinary ideas and innovation are?
Reader, he does not.
Instead we are told that “the many emerging opportunities … include how to handle the deployment of tech and AI”. Tech AND AI! Phew. Now we can feel true optimism.
Likewise, “there will be further big benefits if, in the months ahead, we can make strides on building the NHS online hospital and a single patient record”. Oh, and weight loss drugs …
This is unserious stuff: Team Milburn-Streeting will probably love its detail-free ‘can do!’ approach. Norman Vincent Peale would be proud.
Happy New Year to you and yours: may 2026 be good for you and your families and friends.
Recommended and required reading
Irony first: I’m picking on The Guardian, but every single national media brand ran stories that regurgitated this NHS England press release about the Federated Data Platform AI functionality absolutely uncritically, and without asking for any form of proof of these claimed achievements by AI. How many staff were redeployed? By how much was through-hospital patient flow improved? Journalism is meant to be different from stenography; unfortunately, it usually isn’t.
Hidden Section 40 bungs for 2024-25 are un-hidden by Health Service Journal’s Zoe Tidman.
NHS trials for a fascinating new treatment option for acute-on-chronic liver failure: liver dialysis.
The FT reports on tightening NHS criteria for weight loss drugs. (GLP-1 agonists are the chemical version of a diet: without permanent diet and lifestyle improvements, individuals’ lost fat will inevitably be regained.)
Claims by AOMRC boss that foreign doctors are shunning the NHS due to rising racism reported in The Guardian: be interesting to see some actual data. Interestingly, the FT reports on similar concerns in Germany relating to Syrian medics.
Everybody’s new favourite noble Baroness Michelle Mone is back in the news for the dodgy PPE dealings about which she repeatedly lied.
Interesting bit of social history in the British Film Institute’s NHS archive section.
Another excellent Steve Black ‘Mythbuster’ in HSJ.
Interesting Times business section piece on Mark Davies, chief executive of Primary Health Properties, the FTSE 250 owner of doctors’ surgeries, dental practices and hospitals.
NHS New Years Honours doled out: I was glad to see Greg Fell’s courage during and after the pandemic get recognition.