The Primer provides a rapid guide to the most interesting comment and analysis on the English health and care sector that has not (usually) appeared in HSJ.

If the Sunday media coverage is anything to go by it’ll be another busy week for health announcements.

Briefings to the Sunday papers and an announcement on Sunday night trail capital announcements expected in Wednesday’s spending review, focusing on the elective catch up.

The headline number is £5.9bn new capital funding — it is as yet unclear what this means for total annual capital budgets over the coming years, and how they will compare to what’s needed.

The cash comes with an emphasis on community diagnostic hubs, surgical hubs and IT linked to elective recovery.

What may not be on offer, it appears so far, is a decent multi-year capital settlement for starting to tackle the estates maintenance backlog in a planned way. Nor is it clear if the NHS education and training budget within Health Education England will be protected.

Last night NHS Confed policy director Layla McCay welcomed the promised funds but said: “The Treasury will know that the NHS’ allocation in the spending review falls short of what is needed to get services completely back on track.”

Reports in the Sunday Times and Sunday Telegraph also say there will be some sort of government plan for the elective catch-up in the near future, by the sounds of it featuring some heavy handed list-cleaning type work.

The Times said: “The waiting list itself is also set to be ‘restructured’ with the separation of non-urgent from emergency work. Javid and Johnson believe many patients should not be there, including those waiting for minor operations who have been told they cannot have an operation until they address underlying conditions, such as losing weight.”

All this will dovetail with the push on self management and patient initiated follow up discussed by Sir Jim Mackey last week, and associated projects known informally within NHSE as “waiting well”.

Chancellor Rishi Sunak, appearing on the Andrew Marr Show ahead of his big Budget day, was pressed on proceeds from the Health and Care Levy would genuinely transfer from the NHS to care in a few years time. He pointed to integration between the two - implying some sort of crossover/pooling of the money in future years - which sounds rather like covering up for underfunding in “two leaky buckets”.

The Sunday Times also reported that Javid was ready to announce mandatory vaccination for NHS staff in addition to social care, a tough line which the health and care secretary appears to be very keen to push home.

Plan B, C, D…

Coronavirus has been pushed down the news agenda in recent months, but the debate around how to manage the virus was back with a bang last week.

Rising case numbers and concerns about winter pressures prompted the NHS Confederation to call on ministers to immediately enact their “Plan B” - which involves legally mandating face coverings in certain settings and considering asking people to work from home where possible – and to come up with a possible “Plan C”.

Matthew Taylor, the body’s chief executive, said: “The NHS is preparing for what could be the most challenging winter on record and it will do everything it can to make sure its services are not disrupted but these outside pressures are not solely within its gift to influence.

“As cases of coronavirus continue to climb, alongside other demands on the health service and pressure on staff capacity in both the NHS and social care, leaders are worried about what could be around the corner….

“It is time for the Government to enact Plan B of its strategy without delay because without preemptive action, we risk stumbling into a winter crisis. Also, health leaders need to understand what a ‘Plan C’ would entail if these measures are insufficient.

“The government should not wait for covid infections to rocket and for NHS pressures to be sky high before the panic alarm is sounded.”

The weekend papers featured some tentative signs that things may be moving slowly in the direction of plan B, and indeed that plan C and lockdown measures will be considered.

The Observer said: “In the clearest sign to date that Whitehall is actively considering additional measures, the Observer has learnt that the UK Health Security Agency (UKHSA) contacted local authorities on Friday to canvass their level of support for the ‘immediate rollout of the winter plan – plan B.’”

Watch out for those beginning-of-the-week hospital admission figures.


This prompted the inevitable backlash from those who feel it’s now time to prioritise the economy.

Conservative MP Mark Harper, for example, tweeted: “Lots of noise today about calls from @NHSConfed (the trade union for v highly paid NHS executives £££) to bring back covid restrictions…

“The NHS is under pressure dealing with backlogs resulting from the pandemic. However, Conservative MPs recently voted to raise taxes to hugely increase the resources for the NHS to clear these backlogs It would’ve been nice if [Matthew Taylor] and @NHSConfed acknowledged this today.”

There was a less pointed, but similar sentiment, from Daily Telegraph columnist, Madeline Grant, who wrote: “If we can avoid a return to Chicken Licken-style alarm and despondency then we must, because we have a great deal to lose. It would be a crying shame if the government were to change tack just as the public is learning to live with the virus.”

Subtle manipulation

The response from the government was a press conference led by Sajid Javid, in which he rejected any immediate switch to Plan B, but also threw out the warning of 100,000 positive covid cases per day, and repeatedly stressed the virus has not gone away.

Laura Dodsworth, also in the Daily Telegraph, believes this is all part of a “nudge” campaign, or “subtle psychological manipulation”, to gradually persuade the us all to accept another winter lockdown.

She wrote: “Yesterday, the health secretary Sajid Javid gave the first Downing Street briefing in a month – surely a portentous sign in itself… – in which he announced that covid infections had risen 15 per cent in a week, and warned that cases could hit 100,000 a day this winter.

“But, he continued, ‘if we all play our part, then we can give ourselves the best possible chance in this race… [We can] get through this winter and enjoy Christmas with our loved ones.’

“Why is Christmas even in doubt, an alarmed listener might think?

“These psychological cues are carefully calibrated, more so than many realise. In a document drawn up by the “Nudge Unit” (known formally as the Behavioural Insights Team, a team seat up by David Cameron in 2010; it is now a private company, but is still one-third owned by the Cabinet Office), scientists examine the success of Slovakia’s mass testing programme, looking at how we could replicate that success in the UK.

“Use empowering messaging,” the document advises. “Motivate people by creating a spirit of national resistance to the virus, highlighting the ability to make a positive action and contribute to the national effort to save lives and livelihoods. Use ‘save Christmas’ messaging.”

Not as drastic as portrayed

There is probably truth in that, but Charlotte Gill, writing for the Conservative Home website, summed the situation up more neatly: “It’s worth remembering that Plan B is not as drastic as it has been portrayed.

“It includes mandatory face coverings and advice for people to work from home, for instance. Perhaps its most controversial element is mandatory vaccine passports, but overall, it is not as strict as some of the initial lockdowns.

“And so, the government has given itself leeway here; presenting Plan B as the tough option. It is something it can introduce, should the calls for it get louder, much more easily than initial lockdown instructions. Around the promise of there being ‘no going back’, Javid may be able to stick to his word.”

Update: This story was updated at 9:27 on 25 October to change the amount of capital for elective catch-up from £5.6bn to the £5.9bn in the final announcement