The ongoing Brexit muddle seems like the rerun of another law, the Health and Social Care Act 2012, being passed with a proposed aim but failing to materialise in any worthwhile form, says Andy Cowper

The scene is the Winterland Ballroom in San Francisco, US. The year is 1978, and the band finishing their set on stage is The Sex Pistols.

Their lead singer, Johnny Rotten sneers as his parting words to the audience “Ever get the feeling you’ve been cheated? Goodnight…”

Asked what his question meant in an online chat in 2001, John Lydon (the artist formerly known as Rotten) answered “because I felt I had been personally cheated and the band too and the audience! By – from my point of view – the jealous shenanigans of bad management. We were allowed to resent each other, and left up to our own devices, which unfortunately turned to spite.”

From spit to spite

Mmmmmm. If not mmmmmmmmmmmm.

If anyone is not feeling as if they’ve been cheated by the increasing revelations of misconduct by the Brexit campaigners, then they have not been paying attention.

We saw the miserable withdrawal agreement, which is as good as it could realistically be and simultaneously bad and undoubtedly economically destructive.

Members of the Paying Attention Community will recall the National Audit Office’s stinging report into our national preparedness for exiting the EU.

Brexit: the bonfire of the sanities

I’m starting to wonder whether what befalls Brexit will be the macro political equivalent of dear old Lord Lansley’s hit Health And Social Care Act 2012: a law got passed, but its envisaged aim (in Our Saviour and Liberator’s case, clinically led commissioning and competitive market and patient choice mechanisms), as I have repeatedly written, simply failed to happen in any meaningful way, shape or form.

Instead, what the NHS did was create new and more management bureaucracies. Which, if you are the sort of person who likes that sort of thing, is the sort of thing you will like.

Brexit: the 2012 act redux

I was the first person to note NHS Commissioning Board boss Simon Stevens’ habit of ignoring the shit out of the 2012 act, and instead doing what he thought needed to be done.

I wonder whether dear old Lord Lansley ever gets the feeling he’s been cheated? He should do.

It was, as it always is, instructive to read the peerless Nick Timmins’ take on the possibility of repealing parts of the 2012 act. For the time poor, Nick correctly concludes that it will not be easy, and could take until 2021 or 2022.

As I have written tens of times in this column, NHS finance directors have been directly and indirectly incentivised and pressured to lie about the real financial position. It felt mildly contentious when I was first writing this out loud, but it’s been interesting to observe the system start to admit that it has been so, with NHS Improvement finally getting round to reporting the NHS’s underlying £4.2bn deficit accurately.

Back to John Lydon’s words: “cheated by…  the jealous shenanigans of bad management. We were allowed to resent each other, and left up to our own devices, which unfortunately turned to spite”.

Does that sound like a tune anyone recognises?

The NHS is trying to operate in an environment of no real electoral political policy as I noted last week. Given the quality of our current crop of politicians, this can reasonably be argued to be a good thing. ‘Never Mind The Democratic Deficit’ …

But we have a big unresolved issue: the NHS is therefore trying to operate in the shadow of the policy zombie that is the 2012 act. The Five Year Forward View was a nice idea that didn’t happen because there was not enough money nor a theory of change. Its fine words were not matched with the requisite cash.

In reality, running the NHS in recent years has been about one thing: keeping the car crash as low speed and non-fatal as possible. The system ought to congratulate itself for doing a fairly good job of that.

The 2012 act has not yet been officially pronounced dead. The Five Year Forward View was very largely not born.

The fear for the Ten Year Forward View must be, as I wrote for the BMJ, that its aspirations will not be backed with sufficient cash to be achievable. I don’t think the system could do that twice in a row.

Ever get the feeling you’ve been cheated?