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Editorial Friday 30 April 2021: Who's next? Post-Stevensism, the Mencken Fallacy and the art of the impertinent question

Since yesterday's announcement of the abdication of The Sun King Of Skipton House, Sir Simon Stevens, a lot of people have rushed to ask 'who's next?'

Mmmmm. If not mmmmmmmm. As our classicist Prime Minister Boris Johnson might advise, 'festinare lente': more haste, less speed.

In 'The Divine Afflatus', the journalist H L Mencken proposed that “explanations exist; they have existed for all time; there is always a well-known solution to every human problem—neat, plausible, and wrong”.

The Mencken Fallacy
'Who's next? is an understandable question, but it is also (in the literal sense) an impertinent question.

Going straight to asking 'who's next?' commits the Mencken Fallacy. Starting out by asking 'who's next?' is neat, plausible and wrong.

The pertinent questions to start with are 'what is the nature of the job of running the NHS Commissioning Board as of August 2021?' and 'what kind of person will the people who'll make this appointment want to hire?'

Once we build plausible answers to these questions, then the 'who's next?' question becomes genuinely interesting. But not before then.

Post-Stevensism and post-structuralism
Post-Stevensism runs the risk of being a lot like post-structuralism: there will be an awful lot of bullshit talked in its name, with the aim of denying empirical, observable reality.

Post-structuralism is for onanists: let's hope that post-Stevensism will not be.

This brings me neatly on to the people making and approving the appointment: our current Government. It is led by Boris Johnson, a massive and notoriousliar.

His lying to Parliament has become so blatant and repeated that the Speaker has agreed to investigate effective means of correcting these lies.

This is Not Normal.

On top of this, at this week's Prime Minister's Questions, the Speaker did not rule SNP leader Ian Blackford's
question "are you a liar, Prime Minister?" as out of order or unParliamentary.

This, too, is Not Normal.

The new Not Normal
We are trudging our weary way through The War On Reality, as I wrote back in 2017. Boris Johnson didn't start The War On Reality, and he sure as hell won't stop it, but he is a creature of it and a symptom of it.

The appointment will be made by former Conservative health minister and current NHS Commissioning Board chair Lord Prior of Brampton, and confirmed by Secretary Of State For Health But Social Care Matt 'Alan' Hancock.

Or Alan's successor, of course. There is likely to be a Cabinet reshuffle in June or July.

What kind of person's next?
So, what kind of a person do Lord Prior and The People's Partridge want to appoint?

If you think it's anyone who might prove to be a subtle subversive ... well, good luck to you.

‘Where there is no vision, the people perish: but he that keepeth the law, happy is he.’ – Proverbs 29:18

What's the job next?
Equally, what is the job of leading the NHS Commissioning Board once the Health Bill passes (which with a Government majority of 80, it will)?

What is the job of running the NHS in England once the Secretary Of State For Health But Social Care has explicitly 'taken back control'?

What will the job be for a Government whose political diagnosis of what currently ails the NHS involves a legislative treatment of "more Matt Hancock"?

More things like Test And Trace, and the procurement scandal. Both squarely DHBSC's responsibility.

We need to think about these things first.

So do the potential candidates.

As the White Paper says, “The Health and Social Care Act 2012 put a regime in place which put competition as the organising principle for improvement in NHS care. This has in some cases hindered integration between providers. In practice, the NHS has not operated as the market intended by the 2012 Act …

"The NHS England of 2022 is a very different organisation with a significantly different role to the NHS Commissioning Board of 2013 …

"It has become clear that the more ‘hands off’ role for Government with respect to NHS England that was framed in the 2012 Act has not been realised in practice”.

In the words of Howlin' Pelle Akvist, 'Hate To Say I Told You So'.

But, you know, I did.

There is a lot to be said about the real problems facing the NHS in 2021, and the surreal problems.

One thing will feel very strange to the Department For Health But Social Care about this process of replacing the NHS Commissioning Board's boss, of course: it looks set to be done by an openly advertised and competitive tender. Who knows? That might even catch on.