Andy Cowper shares some bits of actual good news peppered with a dash of a downer at the end.
Because there were a couple of bits of Actual Good News this last week.
(Don’t worry – I’m not heading too far off brand: I do have a downer at the end – or an upper, depending on your point of view.)
The Brexit bonus: political, not financial
At the Nuffield Trust Summit, the peerless Nick Timmins pointed out that for all the current travails of the service, it has at least got a Brexit bonus of sorts. It’s just not the one that was promised by That Bus.
Nick’s words about the near septuagenarian NHS are worth quoting in full. He characterised the NHS in 2018 as “a citadel that’s been holed and decidedly shrunk in placers, and currently under considerable pressure; but one that has repelled most assaults upon it… (and) whatever it may bring in the future, right now, in an odd sort of way, Brexit is protecting the NHS.
“Because the last time the NHS was under this sort of pressure, with the sort of finance and performance it’s in at the moment, which was at the end of the 1990s, there were widespread arguments that we had to actually break the thing up; change the way it was funded; introduce more charges; switch to social insurance; introduce private insurance… arguments running from the political right quite a way into the centre of the spectrum.
“This time around, there is a debate, but it’s essentially about how to raise more tax (whether it’s a hypothecated tax or not). It’s essentially an argument about how we find more money to put into the NHS, rather than how we fundamentally redesign the funding system.
“And that is in part thanks to Brexit. Because the ideas for changing the funding system fundamentally normally come from the right wing of the Tory party, but of course they are the hard Brexiteers. And they were the ones who had £350m for the NHS on their battlebus.
“So it’s really rather difficult for them to argue that we need to change the funding system when the whole point of Brexit was to put more tax money into the NHS. So their voices are currently muted”.
If ever there were an accurate judgement about politics, this is it. Discussing the 2018 mood with colleagues and friends at the Summit, it occurred to me that the mood is demonstrably different from that of 2016 and 2017.
Both of those years basically felt like one long argument about funding. If it wasn’t a bid for more funding, it was a build up to a bid, or a tactical lull.
Oliver Twisting the night away
There are only so many times the NHS leadership can do the Oliver Twist – “Please sir, I want some more?” – without starting to bore itself.
The 2018 mood and vibe seems different to me. It feels as if the question of funding has, like a misleading bus, been parked. It’s evidently not resolved.
But watching the government’s feeble efforts at arse elbow differentiation over what it wants from the EU over Brexit, the sensible view seems to be that Spreadsheet Phil And The Treasury Munchkins (an 80s indie band name that got away if ever there was one) are going to have to discover for themselves that the NHS hasn’t got enough money. Expect their eventual reaction to have all the indignation of a maiden aunt who’s been goosed by an importunate navvy. It could be quite funny.
More money will have to happen. The trigger event is yet to be determined, but there are ample candidates. Financial reforecasting in quarter four could force them to get ahead of the curve of a breach of the Departmental Expenditure Limits that would actually affect UK borrowing costs, since the Office for Budget Responsibility predictions and Treasury forecasts would have to be redone.
And the Financial Times’ excellent Chris Giles suggests that there may be between £7bn and £10bn extra tax revenue on which Spreadsheet Phil and the Munchies have not been counting. Just saying.
The second bit of Actual Good News comes from the data published about the 2017 health questions in the long running NatCen British Social Attitudes polling, jointly sponsored by the King’s Fund and the Nuffield Trust.
And it takes a tiny bit of inference. But inference penny, inference pound: here we go.
If you look at the data about what drives respondents’ dissatisfaction with the NHS, the main responses cannot really in any way be interpreted other than as feeling that the NHS is being poorly run by the government.
Fifty two per cent of respondents cited insufficient NHS staff or length of waiting times; 51 per cent cited government underfunding and 32 per cent specified government reforms that affect the NHS as a cause of dissatisfaction. Only 25 per cent suggested that “money is wasted in the NHS as a root cause”.
Here is an interesting thing: the hard right of a profoundly divided government has insulated the NHS from political criticism, while the general public is starting to blame the government for the woes of the NHS.
This bears repeating: the public are not blaming the NHS for their dissatisfaction (the available proxy for current performance and financial issues): they are blaming the government.
“You break it; you own it”.
A Fraudian slip
Oh, and while we’re on the subject of breaking things meaning you own them, maybe the acute provider sector would like to have a bit of a look at what some of them are doing with regard to the way they measure accident and emergency four hour waits.
And in particular the open secret of how some of you are buggering around with the baseline denominator.
I’m not calling what some places are doing fraud, of course. Heaven forfend! Because if I did that… well, who knows what might happen?
Some of you know.
And I know.
So… let’s not call it fraud. That seems harsh and abrasive. And Cowper’s Cut may be many things, but this column is at all times and in all ways emollient city central.
Yeah. Let’s not call it fraud. Let’s call it a Fraudian slip instead.
How else would we describe the following?
Patients attend A&E; decision to admit is made on patients before seeing them; clock is stopped. Said patients are still being seen in A&E after their records say “admitted”. Basically, this means trusts admitting more and getting the cash, but upon further analysis those patients had no ward stay.
In other versions, you widen the baseline admissions data to include periods when a hospital is likely to be fully staffed and working well (in hours on weekdays), and is selective about how many of the very long waiters (6 hours +) you record.
Then there’s the double counting of non-elective activity.
Oh yes, and if you’re a commissioner, and you’re not wise to these options, why not? Because if this is happening on your patch, then you’re being done.
If commissioners are letting this happen, they are neither use nor ornament.
One might almost wonder why system leading bodies haven’t been all over this like a rash.
I mean, that’s their job, yes?