Andy Cowper gives the lowdown on the interesting, the inane and the insane in the NHS in the past week

Another week, another medley of the interesting, the inane and the insane.

On the interesting front comes this peer reviewed article by Janke, Propper and Sadum, which finds “little evidence that individual CEOs have an impact on a large set of measures of hospital performance. This result is not due to the allocation of good performers to poorly performing hospitals”.

Mmmmmm. If not actually mmmmmmmmmmmmmmmmmmm.

There are probably several columns’ worth of material in this alone. From a scan of the methodology, I think it likely that the research may not adequately weigh the importance and inertia of organisational culture; nor the underlying reasons why chief executives move between NHS organisations.

I am also less than clear whether there is adequate compensation being made for the terms and conditions of the NHS quasi market, with a universal coverage requirement and government/NHS Commissioning Board as a single payer, with significant use of national payment tariff and universal (slightly regionalised) national pay rates.

But it is an interesting read, and I commend it to you (the “demographic and sample characteristics of CEOs” table on page 8 is a particularly arresting read).


The inane and the insane coincide nicely over Brexit, with the government publishing its wildly reassuring work on the health related preparations and plans for a no deal Brexit.

I really, really want to invest in the UK right now.

This took place in the same week as quite possibly the least mysterious and least opaque leak of correspondence in the known health policy universe.

Yes, Minister lore has it that the ship of state is the only one that leaks from the top. As great a line as that is, it seems an improbable hypothesis in this case. It’s massively unclear why almost all of the participants in the correspondence in question would benefit from leaking it.

When you want to understand leaks, you need to remember that water takes the easiest course: the path of least resistance.

Also in the straight up insanity path is this piece about how it’s impossible for NHS Improvement to enter into dialogue about their “interesting” recruitment choices.

Likewise, this piece about how anyone could conceivably be worth a salary of £311,000 pro rata.

Let me answer that one for you, to save you some time.

That is not the market rate that someone particularly talented at NHS finance is worth.

That is almost certainly the result of inept and terrified regulators soiling their pants because they don’t know how to fix major and probably longstanding problems in NHS organisations.

Next week, without fail, I will write about dismantling fences, and the lessons people in NHS management need to learn.