Andy Cowper on why if we collude with a fear narrative by lying about NHS finances, then we are lost

There is a particular kind of ignorance that does a lot of damage.

Normal, workaday ignorance does loads of damage, of course. But today I am not writing about normal workaday ignorance.

Today, I am writing about Treasury Munchkin ignorance.


Last week’s column provoked some interesting non-public feedback. That’s always nice. This week’s column is in part a response to that. In parts, it’s something else too.

One of the criticisms was that I’d been unfair to NHS Improvement in describing their publication of the quarter four financials as “National Lying About The NHS Deficit Day”.

On not understanding the politics of lying

Apparently, several influencers felt that I “didn’t understand the politics”.


None of these people were able to explain why lying about the NHS financial situation was anything other than lying. There is a good and simple reason for this. Lying about NHS finances is lying about NHS finances. And it is going to have consequences. Sooner than some people think.

Irritatingly, I haven’t been able to robustly substantiate several reports that certain NHS Improvement staff had put a page into the Q4 financials describing the true underlying picture of a £4bn deficit (see my previous columns and the invaluable work of Sally Gainsbury of the Nuffield Trust).

And that this pager was deliberatively removed from the public report.


Until I actually have hard evidence, this is an anecdote about a situation being hidden by people who are (understandably) frightened of the consequences of doing anything so radical in the NHS as telling the truth.

Obviously, if any readers have evidence of this, flick me an email.

But that’s not the point.

Why lie?

The point is that I can fully understand why people would lie about NHS finances.

Things are frightening.

The reason I understand why people lie is that too many people are too scared. Fear is an understandable emotion. It’s associated with having something to lose.

We have all got something to lose.

That’s not the point.

The point, if there is one, is that we see that if we collude with a fear narrative, then we are lost.

Here is the problem I have with the Treasury Munchkins: they claim realism.

I would be up for them to claim realism if it (realism) were where they lived.

But it is not.

This is our problem: we have devolved all credible financial decision-making to the Treasury Munchkin community.

This will not end well.

At one level, it is invidious to quote something I wrote years ago.

At another level, everything I know about the conversations currently remains under way between the TM community and those currently anxious about the NHS.


I am very clear that the Treasury Munchkin community requires a productivity boost for the NHS, without which there is no realistic prospect that it will get serious extra funding.


That can be done.

We can make that quite straightforward. You can just straight-up ignore the NHS productivity improvements.

It can even include the data which shows that NHS productivity outstripped the rest of the UK economy.

But the underlying point is this: “Treasury” still believes the NHS is about to spend any new money wastefully.

The reason “Treasury” believes this is about productivity.


The Treasury (or as we refer to them round here “The Munchkins”) need top understanding that any extra NHS funding wlll be investment and not just spending.

The Treasury Munchkins believe only that activity means value.

Oh dear.


We can fix productivity.

All the NHS needs to do is this: to tell the Treasury

Munchkins think that all future NHS patients will undergo a completely unnecessary (if financially safe and viable) procedure during their NHS treatment.

So, each and every time you have a hip or knee replacement, or any other routine procedure, a bit of completely unnecessary surgery looks like that way to increase NHS productitvity.

It’s not a way to add value, obviously.

It’s not a way to add to anything other than units of activity.

But if what we are faced with is going down a reductionist “all that matters is all we can count” nonsense, perhaps what we have to do is satirise the sheer stupidity with which we have to deal?

In King Lear, the Fool tells the King, “thou shouldst not have been old, ere thou hadst been wise”.

The Treasury is 1,004.

Honours even

I mostly think that the UK honours system is BS for the already well-paid and well-recognised.

My general view of the hereditary principle is well-summarised by Bill Bryson’s pamphlet “I’m The Eldest Son Of the Eldest Son Of The Eldest Son Of The Eldest Son Of The Eldest Son Of the Eldest Son Of The Bloke Who Fucked Nell Gwynne”.

But on this one occasion, they got the right person.

Yvonne Coghill is the opposite of Treasury Munchkin idiocy. Yvonne is a grown-up.

If there are honours worth giving, Yvonne is among those who should get them. And I am glad she has done.