Cowper’s Cut 413: Mandygate
This week’s revelations of Lord Peter Mandelson of Foy’s continued, close and corrupt relationship with financier-paedophile Jeffrey Epstein look likely to scupper Health But Social Care Secretary Wes Streeting’s chances of becoming Labour Party leader, and thus Prime Minister.
What a shame that would be.
Control + Alt + Delete
Young Master Wesley’s deleting photos of Lord Mandelson from his social media profiles, as reported by the Mail, will not make much difference.
The electorate in any contest for a new party leader, once enough nominations from Labour MPs to qualify are obtained, is Labour Party members. These people will be well aware of Streeting’s role as a Mandelson protege, and of YMW’s fiancé Joe Dancey having been Lord Mandelson’s political aide (which as the Guido Fawkes website spotted, Mr Dancey has now deleted from his CV).
Discussions about Young Master Wesley as a possible next Labour leader and so PM have long baffled we members of the Paying Attention Community, given the extraordinarily scant improvements to the English NHS under his tenure.
Naturally, there has been a lot of hype, such as the Health Foundation correctly analysed this week with its review of claims over the impact of the Further Faster 20 ‘crack hit squads’, or whatever they’re called. But that (and a ten-year plan) is just what you get when you outsource your thinking wholesale to Alan Milburn, as Young Master Wesley Streeting has done.
The HF piece notes that in March 2025, Team Milburn-Streeting claimed that “in the first 4 months of the programme, waiting lists had fallen twice as fast in Further Faster 20 (FF20) trusts compared with all other trusts not participating in the scheme. Our analysis supported this claim but found similar sized, or larger, reductions in waiting list size were relatively common among other trusts in England, despite the average being lower.
“We also found that the greater reduction in FF20 trusts was primarily due to a drop in referrals onto the waiting list, rather than increases in the number of cases treated (completed pathways)”.
Looking at the situation a year on, the Health Foundation analysis concludes that “the larger waiting list reduction observed in FF20 trusts was mainly driven by fewer referrals relative to the waiting list, rather than more completed pathways (which were higher in non-FF20 trusts over this period). Unreported removals have also played a key role in the waiting list reductions; without these, the waiting list would have increased in both FF20 and non-FF20 trusts”.
So the FF20’s apparent ‘success’ is down to lower referrals and unreported removals. We do not know whether the lower referrals rate is clinically appropriate: we do know that if trickery has been behind these unreported removals, then the people in need of care will inevitably be added back on to waiting lists.
Drily, the HF analysis observes that “we still lack the information needed to understand clearly what effects the programme has had … without further analysis, it is not possible to determined how much of the difference is due to the FF20 programme itself and how much is due to the characteristics of the trusts participating in it.” Oh, come on, chaps! Never mind the mechanism: feel the press release!
Fallout
The fallout from Mandygate has today seen PM Sir Keir Starmer’s chief of staff and senior advisor Morgan McSweeney stand down to take responsibility for his advice that Starmer appoint Mandelson as US Ambassador.
The Times reports on speculation that Sir Chris Wormald, the improbable Cabinet Secretary, will again come under heavy pressure over his ongoing ineffectiveness (a non-secret during his tenure at DHBSC permanent secretary). The likely trigger for his defenestration will be the fact that Wormald was responsible for the vetting process for Lord Mandelson’s appointment.
Who’s next?
A Survation poll of Labour Party members by LabourList suggested that PM Starmer would beat Young Master Wesley in a leadership election by a margin of 53 per cent to 37 per cent, but would lose to former deputy PM Angela Rayner by 48 per cent to 37 per cent.
This aligns with the views of political betting markets that Rayner will be next in charge, and with any sensible observation of how 2024 intake Labour MPs have acted in reality.
It’s worth reading the Hansard Society’s piece on their book ‘Britain Votes 2024’, to help you to realise that the Parliamentary Labour Party, which will decide who can be nominated to go to the ballot of Labour Party members, is basically soft-left, rather than Starmerite/Streetingite neo-New Labour. And the Labour Party’s more, erm, selective membership may not be that differently composed. Sam Freedman’s thoughts on how a Rayner-led Labour would be different also deserve your time.
The Age Of Ange is far from a nailed-on certainty: the HMRC invesigation into her failure to pay the right stamp duty is yet to conclude. But it is very clear that Wes Streeting’s admiration for and former relationship with Lord Mandelson of Foy will be a strong net negative for his chances of leading Labour - and this is assuming that a vacancy arises.
Labour PM Harold Wilson in the late 1960s was lucky in that those in Labour who thought he should be replaced could not agree on how or by whom - in which respect, this piece by Josh Self of politics.co.uk on Westminster leadership contests is also a good read.
Sir Keir Starmer might end up being comparably lucky in his would-be replacements.
NHS DeficitWatch
Shaun Lintern, Health Editor
I wouldn’t be holding my breath for that elective sprint. Shaun Lintern of the Sunday Times picked up on NHS England’s proposals to cap ICB spending on the elective backlogs: in particular, spending with private sector providers, who (reading between the lines) are the main sources for this story.
Shaun reports that “patients due to be seen in January have had their bookings cancelled and rebooked after April 1, when the new financial year begins”. It’s really that glaringly obvious.
So the Labour manifesto commitment comes into direct tension with the ‘break even at all costs’ mantra of Interim Jim Mackey-era NHS England. We have of course been here before in 2016, when Interim Jim was pro tem chief executive of NHS Improvement, overseeing a financial ‘reset’ of the NHS provider sector.
Interim Jim’s statement about that 2016 reset suggested that “this suite of measures will help ensure that the providers facing the greatest financial challenges are supported to bring about rapid financial recovery, while maintaining or improving quality. This plan is intended to restore financial discipline and ensure ongoing financial sustainability across the whole NHS”.
Mmmmmmm. And how did that reset work out?
Crispin Dowler
It didn’t, as those with long memories will recall.
A spectacular miss of the point
There are spectacular misses of the point, and then there is this piece, from The Times. Its hypothesis is that waiting list validation is in fact nefarious attempts to make things look better than they are.
Sigh. This is quite a silly argument, particularly since the RTT waiting list has not been getting very much better. As the recent IFS analysis shows, it is taking more appointments to complete a pathway.
And for a slightly less stupid piece of Times analysis, Tom Calver’s piece on why the NHS is not improving faster with its increased resources is also worth a look.
There is a good argument against paying NHS providers in England to validate their waiting lists, which is that doing so is their core goddamn business. It is impossible to know what the regional presences of NHS England thought they were there to do, if not to check on this most basic of management basics.
But that is not the argument that The Times’ Oliver Wright makes.
Turnout falls further as BMA resident doctors extend strike mandate to August
Do you want the bad news first, or the really bad news?
The really bad news is that they did so on a turnout of 53%. This is only very slightly above the 50% turnout threshold for legality.
Recommended and required reading
The ‘Global State of Patient Safety 2025’ report can be found here.
The National Cancer Plan For England has been updated with more realistically achievable targets, which is probably sensible. HSJ commentary on the differences with past targets is also a key read.
The deal to keep the Trump Administration on side over drug prices will cost the NHS £1 billion over the next three years, the FT reports. And while we’re on the obtaining of drugs, the FT also reports that the number of late-night pharmacies continues to fall fast.
Dr Phil Hammond and Tony Gardner (formerly known as ‘Struck Off And Die’) have reunited for BBC Radio Four, with their new show ‘Doctors On Hold’. It is highly recommended.
Josh Halliday
Dr Susan Gilby, former chief executive of the Countess Of Chester, tells The Guardian that whistleblower protections should be strengthened and that smham investigations are threats to patient safety.
James Titcombe of Patient Safety Watch writes for HSJ that sometimes, blaming (the right) individuals is actually the right thing when a healthcare scandal happens.