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Editorial Wednesday 17 Feburary 2021: The Hancock paradox

There is a not-good report out today from the self-identified think-tank 'Reform'.

I'm not linking to it because it's pretty poor and pointlessly sensationalist in parts, but it suggests that the NHS Referral To Treatment (RTT) waiting list will hit 10 million by this April.

Oh dear.

This is not going to happen, as my HSJ colleague James Illman neatly summarises.

Things are indeed bad in waiting-list-land, and they had been getting progressively bad for years pre-Covid.

James is right to say this will take years to fix. He is also right that this problem is more likely to be fully apparent in April 2022.

James quotes waiting times expert Rob Findlay (a Gooroo on such matters), who goes as far as to tell us that he'll eat his kilt if this happens.

The smart money is on Rob's kilt remaining un-eaten by Easter.

Dull-witted hype comms
This leads me on to a reflection that dull-witted hype-comms such as Reform tried here, with a Big Scary Number, might be becoming less effective.

I certainly hope this is the case, because Reform press statements' references to how the NHS must 'never again become a National Covid Service' betray an embarrassingly poor sense both of taste and of political awareness.

Even in the original lockdown, the notion that the NHS became a 'National Covid Service' was not completely true. It was substantially true of elective inpatient care for a short period for the first wave, and it then became true again in some locations in this latest one.

Primary care, in particular, made major and sustained efforts to continue offering services in the first wave, both online, by phone and in person.

By a 'National Covid Service', Reform presumably means that non-urgent elective cases were postponed and medically fit patients were discharged on 13 March. Yet these urgent routine NHS services were restarted on 27 April: it's in Reform's own timeline. That's six weeks.

Likewise, the NHS has made significant efforts to sustain as much non-Covid care as possible, even in the teeth of much higher infections and hospitalisations in the last ten weeks.

Looking at the timings, the data and the politics, it is hard not to conclude that blame should be put largely on the Government's September 2020 refusal to agree to the SAGE 'circuit breaker' lockdown, which contributed to a high level of ongoing background cases.

This higher community and acute caseload was then unleashed and compounded by the Government's much-publicised Christmas lifting of restrictions, compounded by the increased dominance of the more transmissible 'Kent' virus mutation, which went unchecked by Test And Trace's efforts.

As health economist Professor John Appleby noted at the end of January, "50% of all Covid-19 deaths in the UK have happened over the last two and a half months".

The peak of this current wave has been far higher than the first peak. And even now, as hospitals are getting back towards lower levels of pressure, more services are re-opening.

It is bizarre that this Reform report, given its focus on the absence of much take-up of private sector capacity bought up as a fallback, does not mention anaesthetists.

Treating acutely ill Covid19 patients in the surge ITUs required such significant numbers of anaesthetists that it was very clear they would not be available for extra work in private sector settings. The Royal College of Anaesthetists' Medical Workforce Census Report 2020 shows this very clearly.

The Hancock paradox
But the report did make me reflect again on the 'Hancock paradox': the Secretary For State For The Time Being's heroic assumption that the important answer to the many questions facing the NHS is "more Matt Hancock".

As I wrote for the BMJ, "those who plan to use this legislation for 'taking back control' might have been wise to think a bit harder. The NHS was under massive financial and performance pressure before covid-19 hit. The pressures of the past year have exacerbated all of those problems and left many staff exhausted: many are near, or have already reached, burnout.

"The key point about retaking responsibility for the NHS is that you retake responsibility for the NHS. It looks as though the health secretary will have to learn this the hard way".

The Government's new legislation is aiming to come into effect in April 2022, which observant reads have already spotted above seems likely to be when the full growth of waiting lists will be clear.

The Hancock paradox is that it seems like a good idea to The People's Partridge for him (or his successor) to explicitly take back responsibility (and thus blame) for the NHS and its performance just as waiting lists will be getting really, explicitly and un-ignorably bad.