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Editor’s blog Wednesday 14 April 2010: Talking round objects about NHS policy

You all know the old Yes, Minister joke: hapless minister Hacker writes “Balls” on a bad document.

Nice civil servant Bernard tells him such language is not OK in the civil service. Hacker rewrites, to “Round objects”.

The document comes back form Sir Humphrey, with the further annotation, “who is Round and to what does he object?”

Sometimes, on a bad day, I think I may be talking round objects about health policy. Sometimes, maybe I do.

But the health debate this past week since the launch of the general election has seen truly world-class talking round objects on health policy. To such an extent that it’s been too dispiriting to put fingertip to keyboard.

Conservatives silly on drugs
We covered the controversy over the Conservatives’ NI-saving-funds-cancer-drugs policy, including remarks by Kings Fund chief economist, the iridescent John Appleby.

So it was intriguing to see this press release from the Fund, A statement, no less – one which smacks heavily of having been leaned on, frankly.

The whole fake National Insurance raise furore has been unedifying. The business community is not keen on a tax rise which increases their costs? You don’t say.  Not to mention (repeatedly) that it’s “a tax on jobs”? Wow. I always thought of it as a tax on chrysanthemums. Next thing you know, some genius will reveal that VAT is a tax on adding value and income tax is a tax on income.

The iridescent Mr Appleby’s point was salient: that the proposed tax was 12 months away. That being the case, it was certainly less than clear from the Conservatives’ original statements how the savings would travel back in time, Doctor Who’s TARDIS probably being otherwise engaged.

As such, the phrase “sleight of hand” is a reasonable description. Hence the subsequent explanation that meantime, the funding will come with the bitter taste of CRES – cash-releasing efficiency savings - coming in to flavour the bacon of a pig shortly to fly over Battersea Power Station.

(And anyway, I’ve worked out an exit strategy from the row for iridescent JA – just say you were mis-heard; you were actually saying Lansley is “slight of hand”. Which is true: as my British Journal of Healthcare Management successor-editor Rosalind Hill pointed out to me, “Andrew Lansley has freakishly small hands”.)

More on the manifestos below. But make no mistake, the Conservative Party will be elephantine in its memory of this incident.

The first sign of this came swiftly, in his response to the new Kings Fund report on NHS progress since 1997, A High-Performing NHS?. Lansley told BBC News that the Kings Fund had ignored "the fact that while resources have doubled, the performance of the NHS has not improved as it should have done."

The Fund’s report, by Ruth Thorlby and Jo Maybin, is in fact a sober and realistic assessment of the progress made and the potentialn missed. However, before long, the Fund may find itself dubbed ‘anti-Conservative’ by the Murdoch Augean stable and other meeja Friends Of Dave.

Labour hard of taste on cancer cards campaign
It is delightfully even-handed to be able to observe that Labour shot itself in the foot with matching deftness over the ‘cancer cards’.

A more dim-witted piece of political campaigning it would be difficult to imagine. When it comes to political campaigning, it is wise to engage the brain first. When campaigning about something sensitive,  you should also engage the senses of propriety and decency.

Because your cancer card is going to be read by people who have recently been diagnosed with or bereaved by cancer - or their nearest and dearest. Would you be thinking straight in such a situation?

Me neither. It’s not a massive stretch to see how a personalised communication would be open to misinterpretation.

A better approach would have been a very simple card: nice, smiling photo of Dave Cameron and the following text:

“Tory leader David Cameron plans to abolish all NHS targets (reference here to Dave’s party conference speech).

“Labour’s NHS targets have cut waiting lists to their shortest time ever (reference here), guaranteeing you see a specialist within just two weeks if cancer is suspected (reference). By 2015, Labour want to make that just one week (reference).

“Early diagnosis and treatment of cancer means a better likelihood of recovery (reference here).

“Vote Labour on 6 May 2010”.

Personal? Sure. Just like the Saatchi Gordon Brown ‘vote for me’ posters. But you’re not going to get this kind of fuss.

However. Despite the potential for hitting somebody with cancer or suspected cancer with a personalised card, which is enough to make the Labour campaign a bad move, the facts are that the Conservatives’ stated plans (at that time) were exactly as the cards represent. There is a rather silly Tory rebuttal site here, where you can view the card to confirm this.

Some of the criticism of the Labour campaign, however, was as spurious as it was partisan. The Times piece’s implication -that Labour might have used confidential health data to target this factually accurate but supremely bad-taste campaign - represents an ignorance of how to use Mosaic databases that is either disingenouous or incompetent.

All of the article’s examples are older women, 40 or over – age is a higher-risk vector for cancer. So, for some cancers is the double of having been in higher education and having children later or not at all: databases can and will identify thosde people, and politicians will mail to them because they will probably vote.

Oh, and didn’t you love the 44-year-old television producer who apparently knows her 50 neighbours in Poplar and Limehouse cited in the Times article? She’s either spectacularly friendly, earning overtime as a postman, or the journalists have used some serious poetic licence there.

NHS managers’ pay: the seven percent solution
NHS managers’ pay is always a good one - and Sherlock Holmes fans will recognise the allusion to the Master Detective’s preferred concentration of cocaine.

Our old amigos at Income Data Services have found that yer men and women at the top have pocketed 7% over the past year.

The Independent reported that the IDS “figures show there was a £10,000 "pay gap" between the average pay of chief executives of foundation trusts (£157,500) and non-foundation trusts (£147,500)”.

Umm. There are some very good chief executives out there in the NHS, doing impressive things in difficult organisations. The Senior Responsible Officer thing puts them in the way of unique flak and opprobrium when things go wrong. Their jobs are not very secure.

For those reasons you can make a case – not populist or popular, but a case – for a significant annual increment.

But a CE is also a figurehead. She or he represents something. The job is political, and it would have been good politics for chief executives nationally as a breed to have committed to take no rise more than was given to the lowest-paid 25% of people in the organization, donating the balance to the organization or a staff benevolent fund.

That would have been good politics, good PR and good management.

I wonder if anybody did?

And so to the manifestos …
I was quite hoping the Lib Dems would have joined Labour and Tories in holding their manifesto launch in a building not actually being used for the purpose for which it was built. (The Tory bitching about Labour using a building site that will soon become a hospital made them look really petty).

But no, it was Bloomberg’s.

So, did we get any surprises in the manifestos' content?

Not from Burnhoid’s “preferred provider, though, as it states “We will support an active role for the independent sector working alongside the NHS in the provision of care, particularly where they bring innovation – such as in end-of-life care and cancer services, and increase capacity”.

Pretty unambiguous, that. Like the statement that “central to our agenda for improvement is the hardworking NHS workforce”. Does make you wonder where the lazy NHS workforce are in their plans, though. Because there will certainly be some …

And oh good! Another new target: “to strengthen local accountability, we will increase the membership of Foundation Trusts to over three million by the end of the next Parliament”. Ooo-kay. Would we say, then, that local accountability was very strong in Mid-Staffordshire NHS Foundation Trust? Do we think a Nice Round Number like three million will achieve a critical mass of local engagement and involvement?

Here is one I must have missed: long waits for the chaotic! “Patients who fail to turn up for pre-booked appointments will not be guaranteed fast-track treatment”. Bye-bye, poor people!

The Conservatives’ lovely hardback manifesto doesn’t seem at first sight to have much that is specific,. However, there has been a language shift.

The vow to us, their country, to “free health professionals from the tangle of politically-motivated targets that get in the way of providing the best care”. That’s not a promise to end targets – just a promise to end “politically-motivated targets that get in the way of providing the best care”.

Do you see what they did there?

No, do you really see what they did? They didn’t define “best”.

They will also “scrap the politically-motivated targets that have no clinical justification”. More wriggle-room. As there is in the vow to “stop the forced closure of A&E and maternity wards”. Organic, bottom-up closures will be fine, then?

I mean, apart from the Department for Public Health, and the independent NHS board “to allocate resources and provide commissioning guidelines … (to) make sure that funding decisions are made on the basis of need, and commissioning decisions according to evidence-based quality standards” most of this could be written as “we agree with New Labour”. FTs? Pay for performance? More choice and GP access? Yes, yes, yes, yes! (Sorry to get all When Harry Met Sally)

But as we pointed out, they’re definitely going to abolish NICE: “we will create a Cancer Drug Fund to enable patients to access the cancer drugs their doctors think will help them”. No need for NICE..

The Liberal Democrats are the only party promising less spending on the NHS, which is bold and attention-grabbing in and of itself.

You’ve probably read our stuff with Norman Lamb on Lib Dem policies. They make sense, and they seem realistic.

Elsewhere online …
The lovely Phil Hammond keeps fighting the good fight against a Bristol pathology cock-up-cover-up fusion.

More drug trials and tribulations as pharma companies tell us that the sky is falling.

Berthold Lubetkin’s revolutionary Finsbury Health casntre looks to be facing closure.

The private sector may well not be cheaper than the NHS in Manchester, where GPs are allegedly being strong-armed into making referrals, according to Parliamentary answers.

Virgin’s Assura are lobbying to be able to offer NHS pensions to directly-employed staff.