Andy Cowper ruminates on drawing a line between experience and cynicism when it comes to NHS politics and management

There aren’t as many advantages to getting older as we might think when we’re in school. Getting older is pretty much everything that’s on children’s minds: for them, getting older is a set of keys to a set of doors, behind which lies the future; hope possibilities. 

You know, the good stuff.

Getting older is the balance of disappointments and successes that you find beyond those doors. For the want of a better word, we can call it experience. (That reminds me of one of my favourite lines: “experience is a wonderful thing: it enables us to recognise the same mistake when we’re just about to make it again”.)

If we are careful and fortunate, and if we think, we have the opportunity to balance the suck-flavoured downsides of getting older (your knees go in your forties) with some good things. Done correctly, experience is replacing the yard of pace you lose and the ability to pull all-nighters with better judgment of which battles to fight and instincts informed by something more than socially received guesswork and prejudices.

We can become, in Larkin’s inversion of Ophelia’s great line, the less deceived.

On cynicism

There is a line to be drawn between experience and cynicism. While there’s a lot to be said for the definition of a cynic as “an idealist with awkwardly high standards”, cynicism can easily slip into laziness and toxicity. Nor am I unaware of being quite a cynical person. 

And to be fair, the world of NHS politics and management can by a cynicogenic environment. I have been writing about this stuff for over 18 years. There is an argument to be made that this is too long a time.

There is also a culture at work in much of the NHS, which incentivises bullying, ersatz compliance, obfuscation and a lawyers-first approach. There is a problem with any system that has to supply the centre (or centres) with “the right answer”, come what may. There is far too often a tendency for big figure in the sector only to become candid about the truth of what’s happening in the NHS as they are reaching the exit door or once they are through it.

Then we have politics. I am not a complete cynic about politicians: most MPs in particular put in a lot of hours and are motivated by their version of the public good. I have rarely stood for election to anything, and never on the basis of my politics. I respect them for that.

The nation’s current anti-politics mode, led to no small extent by the right-wing media and exacerbated by the Parliamentary expenses scandal, is a particularly hard-of-thought approach. 

The three amigos

It has taken Britain towards populists and towards angry nativism, which has given us the special, special insanity of Brexit. It is notable that the politicians who supported and are leading Brexit – David Davies, Liam Fox and Boris Johnson – are men opulent in their lack of operational ability.

It cannot possibly have escaped people’s attention that Brexit – the most logistically, politically and culturally challenging thing a British government has had to try since the Second World War – is being led by three men whom one might struggle to trust to run a bath.

Fox and Davies are merely stupid and lazy: Johnson is dangerous. Accurately outed by Eddie Mair as a liar with no moral compass, Johnson is a stupid person’s idea of a clever person, and an unserious politician at every level. It is telling that “Boris” had a column ready both to support and oppose Brexit. Pro-having cake and pro-eating it indeed.

The picture is little prettier in the two main Westminster parties. The left of Labour and the right of the Conservatives are in charge of their parties. As day follows night, they will break their parties. There is not a figure comparable to the former health minister and improver of life chances via Sure Start the late Tessa Jowell to be seen on either front bench.

An NHS visa (card)

The stunning stupidity of the government’s Brexit and immigration policies was laid bare by Wrightington, Wigan and Leigh chief executive Andrew Foster, who tweeted, “Sorry to report that the vast majority of the NW 100 overseas doctors visas have been REFUSED including all those for @WWLNHS I’m trying to find a word to describe the Home Office decision but Trust decency filters prevent anything more than BONKERS!”

As I have repeatedly remarked, the government’s policy towards immigration of essential skilled workforce is a feature, not a bug. The Home Office knows what it is doing.

Andrew Foster is showing moral courage and seriousness in calling out this hog-whimpering stupidity. System leaders across the NHS and its leadership should be lobbying their local MP (the more Tory backbench the better) to incline themselves gently in the chancellor’s direction.

Elsewhere on Twitter, Ipsos MORI chief executive Ben Page tweeted “We’re taking back control! But we may need an NHS visa”. As I replied to Ben, we’re going to need one hell of a limit on that NHS visa card…

And as politics Professor Rob Ford pointed out, public attitudes to immigration are less fixed than they may appear.

Elsewhere, I recommend this article in the BMJ on “why change is hard” and the new NAO report on NHS England’s handling of the Capita outsourcing contract. Cynics will be in business for a while yet.