Andy Cowper sheds light on the policy and politics of healthcare as Simon Stevens closes on completing his tenure.
“I used to organise raves. I used to love raves. But I implore all of those who organise raves to stop. Because you are causing a massive public health disaster”.
Health Minister Lord Bethell (former boss of Ministry Of Sound), September 2020
“Eat Out To Help Out”
“Go back to your offices and prepare for Pret sandwiches”
“I don’t regret what I did”
The world-ready, oven-beating and wildly-underperforming Test And Trace programme has called in yet more management consultants. Hurrah: this is bound to fix all the problems.
At the end of yet another profoundly weird week in the world of health policy and politics, somebody briefed The Times that the NHS will face a change at the very top: “Simon’s off in the spring”.
(This hardy perennial of speculation about Sir Simon Stevens reminds me of the rather unkind comment about my former local MP Vince Cable, that he’d predicted seven out of the last two recessions. If you keep on making the same prophecy for long enough, you’ll eventually be right. Superforecasting, it ain’t.)
Yes, of course Sir Simon Stevens is nearer the end of his tenure running the NHS Commissioning Board than the middle of it. HSJ’s editor pointed this out back in June 2019. These are not jobs that anyone should want to do for ever, even if they could - for both their sake, and the system’s.
Against this theory, we should set a few key bits of unfinished business. Firstly, the legislation to deliver the trajectory of the Stevensism Mark Two reforms (system-working, internal-market-euthanising) has not been delivered, and won’t be by the spring of 2021.
Secondly, the covid-19 blame-game is still in its early stages. There are no rational or reasonable grounds for the government and its allies to try to pin blame onto Sir Simon, but the rational and the reasonable have not stopped this government in a host of other areas. Sir Simon is a sharp fellow, and is unlikely to want to expose himself to the risks associated with allowing blame shifting politicians (and their advisers) the opportunity to try and tarnish his record when he no longer has the power to retaliate.
But as usual with stories blatantly briefed to the media, we need to have a little think about cui bono: who benefits?
The Second Cummings
First up, consider the timing. Do any HSJ readers think that, just as the Second Cummings Wave of covid-19 is about to hit the NHS, a story suggesting the relatively imminent departure of the NHS boss suggests a well-informed source. Nope, me neither: on the contrary, our experience is that strong political judgment and timing have been hallmarks of the Stevens tenure. So we can conclude that the people who did this are quite dim.
Secondly, is a potential replacement for Sir Simon Stevens on prominent show in this speculation-fest? Why yes indeed one is: none other than a key subject of this week’s column: the indefatigable Tory peer Baroness Dido Harding of Winscombe. Proof incarnate that enthusiasm is no substitute for competence, Baroness Harding has this week exceeded her already high standards for total lack of grip of her remit.
Before we even get to the politics, all sorts of constitutional and legal problems arise with the notion that a Tory peer would be likely to replace Sir Simon. The experienced and whip-smart Cath Haddon of the Institute For Government addresses some here, and Labour peer and former Justice Secretary Lord Falconer picks up the theme here.
The Cummings-Johnson government may consider itself to be ever-so-achingly-digital “move fast and break things” kids of guys, but they’ll be heroically unlikely to get away with this. Conservative MPs are already getting fractious with their leadership: and these things tend to end poorly for Tory leaders who lose the plot.
Dido’s deliberate delays and dodgy data
Giving her evidence to the Commons Science Committee this week, Baroness Harding made some rather special assertions.
The noble Baroness told the Committee, “I don’t think anybody was expecting to see the really sizeable increase in demand that we’ve seen over the course of the last few weeks. In none of the modelling was that expected…We built our capacity plans based on SAGE modelling”.
Are we following the science or blaming the science this week? It’s so hard to keep up. Dido’s attempt to blame the Scientific Advisory Group on Emergencies’ modelling: was never likely to stand unchallenged, and Imperial modeller Professor Niall Ferguson promptly told BBC Radio Four’s Today “I should say SAGE was never responsible for predicting demand for testing…The Test And Trace system has tended to plan for demand … SAGE did not anticipate the surge in testing demand - but that its job is to predict likely infection levels, not testing demand”.
Ferguson’s point was neatly reinforced by David Williams, second permanent secretary of Department of Health and Social Care at a Commons Public Accounts Committee hearing this week, when he stated for the record that “(Test And Trace) capacity issues are run through Dido Harding. Those are issues for which I do not have responsibility”. The moments when those who run the bureaucracy start pointing the fingers of responsibility are always significant: this was one.
Another key line from Baroness Harding’s session was that “I strongly refute that the system is failing. We made a conscious decision because of the huge increase in demand to extend the turnaround times in order to process more tests, over the course of the last couple of weeks.”
Let’s think about this. The testing programme is intended to detect covid-19 infections in time to prevent the spread of infections by getting people confirmed with the infection to self-isolate. Extending turnaround times in this way does not let the system process any more tests, which is what the Baroness claims here: it just has the capacity to do the same amount, but more slowly.
There is an obvious perverse incentive here: by deliberately increasing delays in results, it is possible if not probable that those infected (especially asymptomatically) will infect others in the duration, until they get their positive result.
That is a quite remarkable strategy. It is almost as remarkable as the latest plan from The People’s Partridge, Health Secretary M*tt H*nc*ck, to fine people with a positive covid-19 test £10,000 if they are caught not self-isolating. Setting aside for a second the likelihood of a government that has botched Test And Trace successfully introducing a system of such fines and indeed catching people, this creates a huge incentive to get people to avoid testing.
If there’s no positive test, you can’t be fined £10,000. We already know from the ONS “Covid19 Social Impacts” survey that people are not altering their behaviours to self-isolate as it is. The fines approach is unlikely to help.
Don’t worry I’m an economist
Mr H*nc*ck has had another classic week: he has been boasting of his training as an economist teaching him that “if you make something free and easily accessible, then demand often exceeds supply”.
It’s hard to conceive of a more ignorant statement that a health minister could make about a diagnostic test for a pandemic disease. As we approach Season Two of “Covid19 – The Pandemic”, perhaps the time has come to re-cast the actor playing ‘M*tt H*nc*ck’: Alan Partridge has taken the character as far as he can.
Back to the noble Baroness Harding at the select committee: she asserted that testing demand in England from under-17s had doubled, but did not provide any details. As such, it was a meaningless statement, but one that went unchallenged by the committee and the media alike.
While we are on the subject of dodgy data, analysts with the Financial Times reported a sharp slowdown in the release of covid-19 tests in England hit efforts to stop the virus – the proportion of people getting positive results by the end of the day after being tested plummeting from 63 per cent to 8 per cent.
This led us to the truly special sight of a lesson on data accuracy and completeness from the Department for Health But Social Care. Yes! These statistical deities tweeted that “the figures shared by @chrisdrakeuk and used in this article are misleading and wholly inaccurate. They have been calculated using the time taken to return positive tests only, which is a small fraction of total tests taken”.
The fact that positive tests are the ones that matter most seems to have escaped our friends in Victoria St.
The Department For Health But Social Care, trying to hand out a “schooling” about “misleading and wholly inaccurate” statistics, with their reputation?
As former DH chief statistician Jon Hannah memorably wrote of the DHSC’s earlier work on testing data, “I’m looking at a piece of monitoring data having its definition altered only days prior to the target in abject horror. I was already wary of shenanigans, but this really should be the end of public trust in DHSC stats”.
Sorry, 10 million what?
History fans will have noted the FOI release of an email revealing that chief scientific officer Sir Patrick Vallance argued for lockdown earlier and “got a telling-off from chief medical officer, PermSec DHSC and cabinet secretary”, as revealed by the BBC’s Secunder Kermani.
The magnificent behaviour goes to the very top of this government. At Wednesday’s Liaison Committee meeting, Daily Mirror lobby correspondent Mike Smith reported that prime minister Boris Johnson said that he “doesn’t recognise” the “moonshot” target of 10 million tests which a certain PM Boris Johnson announced in a live press conference on national television last week, and which HSJ first revealed had been part of the government’s plans for weeks.
We’d better add amnesia to the list of “long covid” symptoms, then. I have often quoted La Rouchefoucauld’s great line that “hypocrisy is the homage that vice pays to virtue, and fans of this theory may be entertained by this reading from Philippians 2 which PM Boris Johnson gave in Westminster Abbey this weekend: ‘do nothing from selfish ambition or conceit, but in humility regard others as better than yourselves. Let each of you look not to your own interests, but to the interests of others’”. It would take a heart of stone not to laugh.
The week provided other diversions: Twickenham’s new MP Munira Wilson told the Commons that her constituents had been advised to use a fake Aberdeen postcode to game the TAT system was wrong. Mrs Wilson replied as a point of order that her information was right and she could provide proof, and subsequent evidence from a woman who seems to be a Twickenham constituent this weekend appears to reinforce Wilson’s point.
It is all quite depressing, isn’t it? I commend to you Jeanelle De Gruchy, president of the Association of Directors of Public Health’s recent blog on how we should be sorting out the problems with The Cummings Wave. I’d also read the Health Foundation’s recent study on public perception, which shows that the public have noticed the poverty of the handling of things.
This may be driving into the polling data showing Labour and Conservatives tied on 40 per cent each in the latest YouGov poll for The Times. Alongside this, Ben Page of Ipsos MORI showed data revealing that those “very concerned about covid-19 has fallen from 63 per cent to 42 per cent - as it flares up again, we will track this. Polls are snapshots, of course, but they are useful snapshots.
Given all this, who could possibly be a better candidate as the next boss of the NHS than Baroness Harding?
[Editor’s note: Stranger things have happened, of course, and with astonishing regularity in the last five years, than Baroness H becoming the next chief executive of NHS England. But, as Andy would tell you himself, the rumour long predates Covid (and even PM Johnson). Privately, she has always scoffed at the idea…but then, again, stranger things have happened… – Alastair]
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