Julian Patterson is a journalist specialising in healthcare, and the creator of NHS Blithering.
Will NHS England chief executive Amanda Pritchard be as blunt about the funding challenge with ministers as she is with her team? Will she use 'the f-word' in public as freely as she uses it in private?
There may have been sharp intakes of breath and cornflakes among readers, after Health Service Journal reported that NHS England chief executive Amanda Pritchard used 'the f-word' at a meeting of NHS leaders, saying specifically that "the money is a fucking nightmare". (We wish any of you so affected a swift and full recovery from this respiratory distress.)
Not everyone will approve of the tone of her outburst, but many more will see it as a welcome sign of spirit from an NHS England leadership that has appeared bland, aloof and increasingly absent.
Besides, Sweary Amanda is more fun than YouTube Amanda, who just says “amazing” and “brilliant” a lot.
Of course, she was right to point out that funding continues to be the critical short-term issue facing the NHS.
The $64,000 question is whether she will turn the frustration she displays in private into a positive rebuttal of Government plans to squeeze the NHS until the pips squeak.
Forgive the regional team vernacular, but we need to see your balls now, Amanda.
Her predecessor, Lord Stevens of Birmingham, was a poker player who got the NHS a better settlement than it would otherwise have had.
Not too challenging
When Amanda was appointed, there was a suspicion that she was seen by the DHBSC as a safe pair of mittens, a leader who wouldn't rock the boat or deal from the bottom. Nobody in government wanted another Simon Stevens.
Amanda, disparaged as the “continuity candidate”, was perfect for the job: capable but not too challenging.
Let’s hope they misjudged her.
Amanda already knows that the outlook is bleak. Public sector efficiency (the artist formerly known as austerity) is back on the agenda.
The Truss Government has also signalled its distaste for public health initiatives, starting with obesity and smoking. For more than a decade, Conservative governments have opted for the award-winning formula of low spending and low ambition for the NHS, occasionally infused with warm words.
This month’s Health But Social Care Secretary, Dr Therese 'Tiz' Coffey, appears unaware of – and not very interested in – how the NHS, with all its moving parts, really works. See her ABCD nursery rhyme for details.
Nor does she seem all that bothered about workforce, social care, capital investment or IT: the things that will bring the NHS grinding to a halt if they don’t get fixed.
The Health Secretary has reportedly decided to bury a report on health inequalities as being apparently too challenging, even when they are rebranded as 'health disparities'. Perhaps she doesn’t know that sick people cost more, and that you can’t have a healthy economy with an unhealthy workforce.
The Unicorn Hunt resumes
On top of all that, the panic-stricken Government has restarted the hunt for the unicorn of public sector efficiency. Expect to see more headlines about overpaid managers, faceless bureaucrats, lazy GPs and NHS wokery. Expect also to see the Government keep spinning the yarn that efficiency (by which it simply means lower spending) produces better services.
The NHS is already perilously close to imploding. The Government may not have noticed, given that it has its own implosion to worry about.
This is a problem for Amanda, but also an opportunity.
Towards a Government-influencing strategy
What should NHS England's leader do?
She should stand down NHSE director of strategy Chris Hopson and his comms team from their positivity duties, and ask them to do something useful – briefing the media every five minutes with Doomsday scenarios would be a good start. There are plenty of good case studies already, with more turning up every day.
She should make a nuisance of herself, particularly now, while the Government is weak. Ask to meet the SoS for urgent discussions. Make it a weekly thing. Demand read receipts.
She should ask the new Chancellor to put his money where his mouth is. Jeremy Hunt has a good understanding of the NHS, and six years of sin to atone for. Remind Jeremy that he's a changed man. Offer to help him with his list of regrets. It’s time to put that lapel badge to the test.
She should be an overt champion of the NHS and decline to become a mouthpiece for policy that works against the service’s interests. She should swear, if that helps her to make the point, but not too much: Amanda doesn’t have the national treasure status of Miriam Margolyes and this isn't the Today programme.
She should ask anyone who'll listen why the NHS has a line in the debit account labelled “pandemic”. Yes, the public had to find more cash in a global crisis to stop more of them dying. No, we shouldn't be encouraging the public to ask for it back. It wasn't a bonus payment.
Amanda knows all this. Will she fucking well say it?