Cowper’s Cut: The Department For Health But Social Care

Well.

That was interesting, up to a point.

I was wrong about prime minister Theresa May moving Jeremy Hunt. But I was also right about it.

Does that make me Schrödinger’s pundit?

It’s a strange feeling, on the whole. But it won’t be going away any time soon.

So, here we are: the entire world of people who pay attention to Westminster politics (which includes lots of people in the NHS and in social care) now know that the prime minister tried to shift Mr Hunt out of his job.

We also now know that Mr Hunt managed not only to change what passes for the prime minister’s mind, but to persuade her to rebrand his job title and the very Department of Health as the Department of Health and Social Care.

Hello, goodbye

Oh, to have been a fly on the Cabinet room wall last Monday afternoon.

TM: “Hello Jeremy. I want to thank you for all your hard work and endurance, but I think we need a fresh start at Health, and I think you should broaden your experience by moving to BIS”.

JH: “But prime minister, I’m actually the only possible secretary of state for health you’ve got. You reappointed me once already, remember? It wouldn’t look very strong and stable to move me, would it?”

TM: “Well …”

JH: ”In fact, prime minister, I’m doing so well with the NHS (which missed all its national targets last year for the first time since they were invented) that I think you should give me social care to run as well.”

TM: “Splendid idea, Jeremy. You’re hired.”

Auto-satire

I can’t remember what it was that triggered me to observe that the coalition government had started to satirise itself unusually early in the electoral cycle. Let’s be frank, there were A Lot Of Candidate Moments. 

Whatever drove that thought, one cannot fail to have a sneaking admiration for the way that the current government put the coalition’s not inconsiderable auto satirising effort in the shade.

It has been suggested that creative jobs will be safe from automation, but prime minister Theresa May (who is essentially a very shit at politics robot) is making satirists redundant by the score.

She is satirising her own government.

Set aside for one moment the fact that Jeremy Hunt literally personified the Dunning Kruger Effect, the prime minister has reappointed and broadened the job of a man who has not got any kind of plan for the NHS.

More tequila

We are going to need more tequila, people.

Social care is not the only problem making things bad in the NHS, but it is a fairly big contributor to delayed transfers of care for acute providers.

The much bigger system wide problems are the culture; the lack of stealing good practice; the complete lack of any workforce plan or strategy; regulatory overload and overlap; and the rising demand outstripping resource.

If Jeremy Hunt has got a clue what to do about any of those things, he’s kept it mighty close to his chest.

Social care is broken, because of deliberate decisions by the coalition government and the current government to remove vast amounts of the Revenue Support Grant. The government’s permission for local authorities to levy a small precept on council tax does not come close to thinking about touching the sides of this funding hole.

Social care providers are exiting the market as if there were no tomorrow (which means that for quite a lot of people who need social care, there won’t be).

Mrs May has missed a prime opportunity to rebrand the DH as the Department Of Health But Social Care.

One of the best commentators on the Conservative and Unionist party is The Spectator’s assistant editor Isabel Hardman. Her piece on what the government plans to do with social care is fascinating if not very heartening reading.

Hardman reports that “Hunt will be taking control of the government’s green paper on social care, which as I’ve been reporting, hasn’t been so much kicked into the long grass as chucked into a forest so that no one raises the toxic issue in the way they did in the election. The health and social care secretary is known to have been frustrated by some of the lack of enthusiasm for coming up with a long term solution for social care funding, and has been pressing for a while for the NHS and social care to be better integrated, so his request for more control of the policy makes a great deal of sense.

“I understand, though, that there are no plans to change the mechanism by which local authorities are funded for social care, which is through the local government finance settlement, administered by the (renamed) Ministry for Housing, Communities and Local Government.

“But all options are on the table for the long term funding question, and Hunt is likely to be keen to want to consult very carefully on any proposals, given one of the reasons the manifesto pledge on social care fell apart was that no one (including Hunt) had been consulted on it before it was announced.”

Phew. Now, I’m reassured.

What could possibly go wrong?

In parallel to this, we have seen the ongoing emergence of a desire to have a heated debate about how we fund the NHS.

Many things may be rationed in today’s NHS environment, but stupidity is not one of them. This is so, so spectacularly stupid a diversion that I won’t even devote a column to it; just a couple of paragraphs. Then, maybe we can not waste any more time on this complete nonsense.

The method of NHS funding is really not the pertinent question. Every significant review, from Guillebaud to Wanless to Barker to Dilnot, concludes much the same way.

The level of NHS funding very much is the question. The answers are quite consistent there, too.

The public has noticed that there is a problem with the NHS and funding, and the public thinks more spending is probably needed. 

Further debates about how we do NHS funding are like dancing about architecture: feel free, if you must, but be very clear that it won’t change anything. It’s time to stop fucking about and get on with it.

What the NHS is

It’s pretty easy to get it wrong about what the NHS is.

At one level – an important level – the NHS is a funding mechanism to make healthcare universally available (mostly) free at the point of need, not based on the ability to pay at that point because you’ve already paid through general taxation.

Another conception of the NHS is as a bunch of buildings, and changing things about them can be hard. (Of course, the NHS has been closing beds and changing service provision since 1948, but ssssh! Don’t tell anyone, because it’s all privatisation …)

But you’re the kind of person who reads and pays attention to this column, so you already know what the NHS is.

The NHS is the staff. And vice versa.

And right now, those staff are under ridiculous pressure and strain in far too many places. The good leaders in the system know this, and are doing what they can. But it’s not enough. They know it; their staff know it.

And nobody has got a plan to fix this.

Until someone gets that plan, we’re Donald Ducked.

As The Bard so very nearly wrote, “the quality of strained is not mercy”.