Trying to get the balance right between pessimism about the real problems and due optimism about the achievements of parts of the health service matters, says Andy Cowper

One of my favourite NHS observers is Julian Patterson of NHS Networks. His weekly blogs are a source of satirical comfort to many about the madness that so often passes for management, ranging from the hilarious to the horrific.

They are consistently very, very funny. 

Needless to say, I have shamelessly nicked quite a few of his jokes. Julian is a lot funnier than I am: I need all the help I can beg, borrow or steal.

But like any good satirist, Julian is using his humour to make serious points. Julian’s latest is a brilliant dissection of the jargon-speak tendency.

He has long been acutely funny on the service’s chronic tendency to use deliberately non-specific language such as “towards”, “view” and “aim”: anything that suggests pointing towards a medium-to-long-term worthy goal without making any definitive commitment as to how to get there, nor by when.

I think we’d both agree that the impact of humour and satire on the reality of the NHS policy continuum has not been great. Put simply, people still aren’t nearly embarrassed enough to talk 1980s/90s-style business jargon bollocks about NHS management.

Language matters: it reveals thought (or the absence thereof). I have previously used the fabulous quote from Ben Johnson’s Timber: Or Discoveries Made Upon Men And Matter that “language most shows a man; speak, that I may see thee”, and it bears another repetition today.

If we can’t speak clearly, then we probably haven’t been thinking clearly.

And trying to get the balance right between pessimism about the very real problems and due optimism about the many excellent achievements of parts of the health and care service and system matters.

Unsound money

The latest quarter’s figures from NHS Engroovement-Improveland confirm that the money is going off track again, already. Which is no surprise, as the new money doesn’t arrive until next financial year. (In the interests of the aforementioned balance, the four-hour accident and emergency waiting time figures showed improvement in that quarter.)

The estimable Sally Gainsbury of the Nuffield Trust has chronicled the service’s financial woes and Treasury Munchkin chicanery with consistent clarity, and it is hard to better her analysis that “A remaining hole of £2bn or more will need to be closed through more cost cuts, and emergency bailouts will have to continue for at least the next three years”. So, I won’t even try. 

Revealed preference

I will observe that the revealed preference of the political class and Treasury Munchkin community has been to provide the NHS with the bungs it needs to pretend to keep financially upright, but only at the eleventh hour, fifty-ninth minute and fifty-ninth second.

The politics of this are interesting. I’ve lost count of recent years’ emergency bailouts, funny business with employer NI contributions, and Department For Health But Social Care’s 6 per cent interest-bearing loans to financially sub-marine NHS provider trusts.

This has been mirrored in the NHS’s getting providers to lie about their financial positions so they could get the first three quarters of the year’s incentive funding. Whoops: in Q4, we suddenly find we have a Big Deficit! Who knew?

The revealed preference of the Treasury Munchkin community is to give the NHS bailouts only at the very point of its breaching the DEL.

There is no obvious incentive for this not to remain the case. So, we can safely assume it will continue.

People are starting to notice, as the latest year’s worth of the health questions in the long-running and highly-respected British Social Attitudes survey sponsored by the King’s Fund and the Nuffield Trust demonstrate.

The BSA survey found that public satisfaction with the NHS overall has continued to fall, to the lowest level reported since 2007.

An interesting stat at the bottom of the press release was that satisfaction with social care runs at 26 per cent, which is still slightly better than public satisfaction with Jeremy Corbyn as leader of the opposition, which is 19 per cent.

But not much. So, I was very intrigued to see that the American RAND organisation, which is significantly funded by the US government, looked at UK public attitudes to funding the NHS and social care, and found that “all sections of the public — across age groups, income groups, employment status, health status and countries of the UK — would on average like additional funding for social care to be raised in the same way as additional NHS funding.

“Across all sections of the population, people prefer on average a collective rather than individualistic approach to raising additional funds for both healthcare and social care.

“There is a preference for the percentage of income paid to be higher for people on higher incomes, ie for a progressive system. Those in higher income groups supported this too on average, albeit not quite as strongly as people on lower incomes.

“All age groups on average prefer that contributions should not differ by age. Older age groups had a stronger preference for this non-discrimination but even the 18-24 age group did not on average want over-40s to pay more than younger people.

“There is a strong preference on average that raising additional funds for both healthcare and social care should be by a public body rather than a private company”.

That feels to me like cause for some of that rare thing, optimism.


It wouldn’t really be a Cowper’s Cut column without recording for posteriority -everyone’s favourite Secretary Of State For The Time Being, our PC Word loyalty-card-toting, poor man’s Chris Grayling, ’Appless Matt ’Ancock having done something stupid.

Asked by Channel Four News if he could guarantee that no one will die as result of consequences of no-deal Brexit, Mr ’Ancock said, “we don’t use word guarantee in NHS”.

Reassured? Me too!