Cowper's Cut: Pretentions towards seriousness

Sydney Newman, the BBC TV producer instrumental in creating Doctor Who, once described the programme as needing “pretentions towards seriousness”. This could have been when he was admonishing the first producer Verity Lambert for her green lighting the Daleks, which Newman decried as “bug eyed monsters”, contrary to the seriousness ambitions. The admonishment faded fast once Newman saw the viewing ratings.

Looking around the world of NHS leadership and policy this week, it’s been a challenge to spot signs of pretentions towards seriousness.

The biggest example, fortunately, is outside the NHS’s immediate policy and management infrastructure.

That is the unutterably depressing saga of the Home Office blocking the visa applications of 100 doctors who have been recruited to come and work in the NHS.

I touched on the Home Office’s and government’s policies on immigration last week, only for my piece to be labelled “left-leaning”, “emotional exaggeration” and for me to be invited to become a Labour MP by below-the-line comment-mongers who are epically astute readers of my politics. (It’s nice to see that HSJ’s readership is diverse enough to include a few members of the deeply confused and hard-of-thought communities.)

It is depressing if not surprising to see that the Home Office, very much formed in prime minister Theresa May’s image as its head from 2010-17, has offered no meaningful defence of this act of political sabotage.

Error, incompetence or intent

There are three broad root cause explanations when a government department screws up: error, incompetence and intent. As I discussed last week, ”hostile environment” and negative attitudes towards immigration are not a bug of Home Office and government policy: they are a feature.

The above news article also quotes from a letter from NHS leaders to the Home Office asking that for the policy on the cap on ”certificates of sponsorship” to be altered to exclude applications for shortage occupation roles such as nursing.

By God, do we need this. The long-running Whitehall farce of Brexit has already hit nursing numbers, as new data released this week by the Nursing and Midwifery Council sets out in stark detail.

The NMC data shows “a significant rise in the number of EU nurses and midwives leaving the register. Between April 2017 and March 2018, 3,962 people left – an increase of 29 percent.

“There continues to be a dramatic drop in those joining the register from the EU. Over the same period 805 EU nurses and midwives joined the register compared with 6,382 the year before – a drop of 87 per cent.”

As EU-sourced nurses leave (yes of course, there could be reasons other than Brexit – like the deteriorating value of sterling earnings caused by … oh yes, Brexit), it is unsurprising that the NMC data shows “the number of nurses and midwives joining the register from outside the EU has also risen for the fourth consecutive year with 1,093 more nurses and midwives on the register compared with March 2017”.

But 1,093 is not even a third of 3,962. Nor can this retrospective data show us the effect on current or potential non-British staff’s attitudes of the Windrush scandal. Here’s a prediction (and regular readers know that my predictions are always right, except when they’re wrong): the Windrush scandal just might not burnish the British reputation for fair play and decency.

Fair play and decency matters a great deal in the NHS, which is why it was saddening to see the influential patient leader, mental health activist and writer Alison Cameron writing in highly critical terms about her treatment by Horizons, a national improvement support unit funded by NHS England.

I can’t tell you whether all of these allegations are correct. I can tell you to have a look at Alison’s barnstorming speech to the 2015 NHS Confederation annual conference. And once you’ve done that, well, you can make up your own mind about her reliability as a witness.

At the very least, Alison’s staggeringly courageous candour about her history as a patient and her time in addiction and homelessness should have made anybody in any NHS-adjacent organisation take extraordinary care in all dealings with her.

If Alison is to be believed, that didn’t happen: not by a long way.

If that is the case, then the system has let her down extremely badly, and has let itself down far worse.