Good day, I hope this finds you well.
You should go first to our latest instalment of The Maynard Doctrine, in which the good Professor fetters out the pearls from a goldmine (he mixes his own metaphors) from a report by the Commons Health Select Committee. It's very good.
You'll also probably be watching tonight's BBC Panorama, which continues to probe the dodgy data debate. Dr Foster's Professor Brian Jarman is quoted extensively and to telling effect in this revelation of the inaccurate self-assessment by 60% of the trusts investigated by the CQC.
Andy Burnhoid: The misunderstood Boy Wonder
You may have seen my comments last week about health secretary Boy Wonder Andy Burnhoid's latest stab at preventing the near-certain over-ruling of his "preferred provider" policy.
Burnhoid has since apparently suggested, according to Gareth Iaccobucci of Pulse, that his comments have been "misunderstood".
Ooookay. Let's assume that has happened, which would be odd, given the ease with which his speech could be found online and the Kings Fund even had a recording up on their website, here.
So what clarification does the Boy Wonder offer in the exclusive Pulse interview? What misunderstandings does he turn into understandings?
He does say that the guidance is coming shortly.
And there is some waffle about how much it matters to staff that they're working for the NHS (which will be why the question about whether staff would be happy to be treated by their own organisation got mysteriously dropped from the NHS staff survey, because the 'yes' reply rate was not so high).
What he does say is "NHS preferred provider means that people get a chance to change if there’s a challenge in respect of under-performance or if there needs to be service reconfiguration. Where it affects existing staff, doing existing jobs, and existing NHS services, they should get the chance and the space to change before you would ever go out to an open market tender (my underlining). I would defend that position to the hilt because I believe it’s the right, fair and common sense position to hold"
Burnhoid adds, "this preferred provider change is very important in terms of recognising that the NHS is entering a different era where it is not simply about adding new services. We have to look at changing existing services ... when we were adding on new capacity, it doesn’t affect of (sic) threaten anybody’s jobs. But when you are having to change the system to meet the new efficiency requirements, I think you need a fair set of ground rules that lets everybody know where they stand, and which recognises that working for the NHS matters to people ...
"That doesn’t mean I’m against other forms of provision, I’m just simply saying, give them a fair set of rules. The other thing to say is, I expect there to be more challenge, not less, and if NHS provision doesn’t come up to the mark, then there is no excuses. We can’t tolerate poor provision just because it’s NHS provision".
Phew. Where can I start?
His assertion that "when we were adding on new capacity, it doesn't affect of (sic) threaten anyone's jobs" - erm, ISTCs, anyone? They definitely affected, and depending on whom you believe, threatened people's jobs by destabilising NHS providers. Not to mention this being just about as conclusive proof as could be required that 'world-class' commissioning has been a dismal failure.
The fabulous idea that because "working for the NHS matters to people", you can suddenly, after a decade of pro-choice policies, chuck it all out of the window. The NHS pension demonstrably matters to NHS staff - it's why so very few left to form co-ops and social enterprises. No surprise: it is a fantastic deal. But it was made such a fantastic deal at a time when NHS pay was markedly below a reasonable average. For most staff, that is no longer the case.
And the expectation that the crap commissioners and poor judges of quality will all of a sundden start to offer "more challenge, not less" is optimism of the Pollyanna-meets-Micawber school.
The never "ever" market: how much is that dogma in the window?
But what is quote staggering is his line about "before you would ever go out to an open market tender". Now it would be a hardcore market ideologue who suggested that all services should go out to open competitive tender.
Equally, it requires another such ideologue from the opposite end of the spectrum to suggest, which Burnhoid explicitly does, that market tendering is a 'never' event. That there is not one single NHS-provided service whose performance is so poor that it would justify the immediate move to an open market tender.
Telegraphing "a heated debate"
Caroline Arherne's fantastic Mrs Merton was one of the comic creations of the 1990s; never more so than for her "let's have a heated debate!" send-up of the painful and slow death of thought that is the TV studio debate.
This week, wants to have "a heated debate" about the NHS. So we start off with a fatuous editorial call for a full-scale debate, and then a curate's egg of a contribution from Professor Nick Bosanquet and Andrew Haldenby of Reform.
Bosanquet and Haldenby make some good points, and score some of the more blatant open goals. I like Nick Bosanquet - he's funny, and has often been right.
However, two sections of the piece are spectacularly silly, and badly let down the rest of their argument.
Their piece asserts that “The NHS spending increases are the single biggest reason why the public finances are in such a dire position". Oops. Telegraph subs must have had a thirsty weekend to let that one through. We don't think that the recessionary collapse in tax take, rising welfare bills and baling out the banks have had a much, much bigger impact?
It also suggests that the wasteful spending “is not the fault of the much maligned Private Finance Initiative (which has actually resulted in a much better use of taxpayers' funds). It is a simply a matter of big NHS over-spending on hospital building and refurbishment in recent years". Which is, as far as I can discern, utter nonsense.
Even fans of PFI tend not to argue that there has been any meaningful transfer of risk to the private sector. One positive of PFI is that it takes the option of neglecting maintenance off the table. One negative of PFI is that, as Bosanquet and Haldenby rightly nail, it leaves you with today's (or now, yesterday's) concept of a healthcare facility, when the delivery of healthcare needs to change.
But a bald assertion that PFI "has actually resulted in a much better use of taxpayers' funds" does the authors little credit. There is little evidence that this statement is true.
And finally ...
This comment from BBC Online's FOI blog is food for thought. I'm all for disclosing people's pay, as I've written on here and elsewhere previously. The Lister Hypothesis suggests that a staff list should be found inside the front door of every workplace, with salaries appended: the rationale being that it should be possible to justify what you earn.
Others have had similar thoughts.
Good day, I hope this finds you well.