Cowper’s Cut: The ‘pin the blame on the donkey’ game gets under way

The Budget turned out slightly better for NHS funding than many other people and I feared, but the fundamental point of last week’s column still stands.

The NHS funding crunch problem has been temporarily deferred, but very much not resolved.

The politics of this Budget are the equivalent of dealing with a large and messy pile of fox shit outside your front door by kicking some autumn leaves over it.

So, now we get to play the “pin the blame on the donkey” game. Which is every bit as much fun as it sounds.

And into this delightful environment came an interesting double sourced leak to The Guardian, which was a first attempt to pin the blame for chancellor Philip Hammond’s NHS funding decision onto NHS Commissioning Board chief executive Simon Stevens.

Less is more

Oh yes. These two “anonymous” (but not hard to detect) sources think that the NHS got less money in the Budget because Simon Stevens pointed out that the NHS needs more money.

They said that out loud, in the real world, to the reliable Denis Campbell.

As Oscar Wilde reportedly said of the death of Little Nell, “One would have to have a heart of stone to read the death of little Nell without dissolving into tears… of laughter”.

I wonder what these two anonymous sources meant by that?

When an individual is being briefed against (as Simon Stevens rather flagrantly is here), the sensible response is to wonder why. Cui bono? Who benefits? Or who thinks they benefit?

The purported logic behind these two sources’ argument is heroically flimsy, but I’ll debunk the most glaringly obvious bits for a laugh.

One: Philip Hammond was “furious” (Denis’ use of quotation marks throughout is skilful in pointing those in the know in the right direction as to his sources’ identities).

Oh dear. You really don’t have to be very close to Westminster politics to be aware that Speadsheet Phil does not do fury. KitKats, yes: he does KitKats. Fury, not so much. 

Two: the Treasury was going to give the NHS more money than it did, but was embarrassed by Simon Stevens’ speech and thought it would set a precedent for every other public service.

When an individual is being briefed against (as Simon Stevens rather flagrantly is here), the sensible response is to wonder why. Cui bono? Who benefits?

Oh dear. No other public service has the semi arms’ length relationship with its chief operating officer that the NHS does. Advocating for the NHS is not Simon Stevens going rogue: it’s Simon Stevens doing his job. 

Neither anonymous source is quite so wet behind the ears as to be unfamiliar with the 2012 Act bequeathed to a grateful nation by dear old Lord Lansley (it just seems as if both men are.)

This despite the fact that all of the public sector is under significant financial pressure. Social care has already fallen apart. There are riots in prisons on what feels like a weekly basis, and suicide rates in prison are at an all time high.

You want more evidence that the Treasury doesn’t embarrass easily?

Look at the fact that defence minister Tobias Ellwood has threatened to resign if he is forced by the Budget to cut the Army yet further. That’s a serious bit of lèse-majesté meets abrogation of ministerial responsibility. He hasn’t been sacked.

Look too at the fact that there was no comparable briefing against police chief Sara Thornton.

Three: the Treasury was plausibly going to give the NHS more money than it finally did if the Stevens speech had not been made.

Oh dear.

HSJ readers will have been well aware that the entire health sector, from national system leaders to think tanks to representative bodies was making that much noise about NHS funding throughout the past four weeks because everybody was hearing (as I was) that the Treasury plans were to give the NHS just enough extra to fulfil the manifesto commitment so that 2018-19 would have been revisited to provide 0.1 per cent above inflation.

From Santa to Scrooge

You can believe that every single one of those organisations was in the dark about the Treasury’s real plans to be the NHS’s Santa Claus, and only turned into Scrooge because Simon Stevens gave a speech. 

Right. 

You can believe that. And if you do, I’ve got some real estate in Florida I can sell you at a really great price. “Ho ho ho.” Or maybe “bah, humbug!”

No: the idea that Simon Stevens backed Philip Hammond into a corner to give the NHS less money than it might have had is plausibility light. 

It’s also unfalsifiable, like all the best conspiracy theories.

The mental gymnastics involved in simultaneously believing that the Treasury began accepting that the NHS seriously does need more funding (and it does), when at the start of November most of the health policy world was clear that very little more money looked likely; and then refused to act on that realisation because of a speech by Simon Stevens are Quite A Thing.

The idea that Simon Stevens backed Philip Hammond into a corner to give the NHS less money than it might have had is plausibility light. It’s also unfalsifiable, like all the best conspiracy theories.

(Well - those mental gymnastics are either Quite A Thing, or hog whimperingly stupid. One of the two, definitely.)

That does not sound like a civil service decision, does it?

That sounds like a political decision.

And there’s a very interesting hero gram subtext to one of the sources’ contribution to the Guardian story, making it very clear that the next alleged Conservative Party leader aspirant Jeremy Hunt was the man in charge of wrestling more cash out of the chancellor.

Mmmmmm.

Oh yes, and for those of you who enjoyed Philip Hammond’s fictional fury, Simon Stevens was allegedly “angry” about not going to key meetings. Getting angry doesn’t sound very Simon Stevens. Getting even is more his style.

And as the always shrewd Huffington Post politics editor Paul Waugh observed, “How can you attack Stevens for going public when you keep him out of the private negotiations?”

So, the second source for this story is a man who thinks he could plausibly act as a conduit between the NHS and the Treasury, Department of Health, Whitehall and Number 10.

Nice bit of hubris you’ve got there.

A game of political football

Playing political football with your opponents successfully requires tactics, technique, tenacity and timing.

These two sources think they’re playing in the Champions’ League: their efforts might get them a bench slot in the Rymans League. Political football’s not the winner.

Neither are these sources.

This crass and feeble attempt at news mongering does tell us one important thing, though: the government and its special advisors and its supplicants are very, very scared about the NHS. And they don’t know what to do.

The Conservative Party is traumatised to think about the NHS due to dear old Lord Lansley’s legacy.

The government is scared that NHS funding is not right, and that it will come back to haunt them. With good reason.

So, others must be to blame.

This crass attempt at news mongering does tell us one important thing, though: the government and its special advisors and its supplicants are very, very scared about the NHS. And they don’t know what to do.

Except that others are not to blame. NHS funding is the political choice of the government of the day, and the British electorate know that.

My late friend Professor Bob Sang was fond of using four quadrant diagrams to set out conceptual theories. You know the kind: often effectively a  strengths, opportunities, weaknesses and threats or SWOT matrix.

Bob used one that I’ll never forget: he put up “things we know will work; things we hope will work; things we know won’t work; and things we hope won’t work”.

There is plenty for us to consider in that last “things we hope won’t work” category.

HSJ’s readers run the NHS, and have mostly been scared about the NHS for some time. With good reason.

I’ll come back to the subject of fear in next week’s column, and probably quite a few thereafter.