Andy Cowper: The Treasury’s back – and so is Dom

The Department of Health and Social Care – and its secretary of state – has had another month in the headlines. But did it just see its future in the school funding row?

By Andy Cowper

08 Jun 2021

The most important event in government policy and politics as regards health and care over the past month was in education. Sounds odd, but it’s true.

Sir Kevan Collins’s resignation as the government’s education catch-up tsar might not instantly have got you thinking about the health and care sector. But it should. Because as many shrewd observers swiftly noted, it marked the re-assertion of the traditional Treasury mindset over public spending.

The pandemic enforced huge increases in the state’s role as the lender and spender of last resort. Collins’s bid for £15bn over three financial years for educational catch-up did not seem (and probably wasn’t) outlandish, in the context of the £37bn made available for NHS Test and Trace, or the £340bn approximate overall cost of the Covid-19 crisis response.

Guess who’s back? The Treasury

The government’s proposed decimation of the sum requested – they offered just £1.4bn – sends an unambiguous message: the magic money tree has been fenced off. The Treasury – the bank that likes to say “no” – is back in the driving seat, so fasten your fiscal seat belts nice and tight.

Of course, this matters for every part of the government and the civil service. Yet maybe it matters most of all for the health and care sector. Here are a few reasons why.

The NHS waiting list was huge before Covid-19 hit. It now stands at almost 5 million people: the longest since accurate records began. NHS workforce shortages remain significant, and the capital and maintenance backlog hit £8bn last year.

Social care still lacks any sign of the government’s long-promised plan.

On top of all this, dealing with Covid-19 has left much, if not most, of the workforce stressed and tired, and possibly traumatised. Their reward? Staff in the NHS in England have been offered a 1% pay rise.

Cometh the hour, cometh the Dom

The past month has not, however, been without some fairly high-profile news. And civil servants in all areas of government would be forgiven for having ordered in popcorn and some suitable liquid refreshment for the man who infamously promised (borrowing from octogenarian song-and-dance-man Bob Dylan) a hard rain on the civil service.

Cummings was on incendiary form over the seven-hour session. He apologised several times for his own part in the failures of the government.

According to Cummings, a senior DHSC official told then-deputy cabinet secretary Helen MacNamara that the long-vaunted pandemic plans did not in fact exist.

MacNamara went straight to see Cummings in Downing Street, reportedly saying: “I think we are absolutely fucked. I think this country’s heading for disaster. I think we’re going to kill thousands and thousands of people”.

The alleged Hancock-ups

Cummings also shipped copious amounts of blame straight onto secretary of state for health and social care Matt Hancock.

When Rosie Cooper MP asked Cummings to Ofsted-rate the performance of DHSC and Hancock (outstanding, good, requires improvement, inadequate), he replied: “I think the secretary of state should have been fired for at least 15 to 20 things, including lying to everybody on multiple occasions in meeting after meeting in the cabinet room and publicly… I said the secretary of state should be fired; so did the cabinet secretary; so did many, many other people”.

Cummings said: “There were lots of great people [working in DHSC] but the procurement system which they were operating was just completely hopeless. On the day the PM tested positive, I was told by officials that DHSC were turning down ventilators because their price had been marked up. It completely beggars belief that sort of thing was happening. I was having PPE meetings that said delivery will take months because shipping stuff. Why shipping? Because that’s what we always do. I had to leave meetings, tell people to commandeer planes, go get the PPE.”

Cummings also criticised Hancock’s pledge to hit 100,000 tests a day by the end of April 2020 (which was only met by gaming the numbers). He claimed that Hancock contradicted his directives to get test and trace properly established for the long term, diverting staff and holding back tests to help in hitting his 100,000 pledge.

“He should have been fired for that alone. That itself meant that the whole of April was hugely disrupted by different parts of Whitehall fundamentally trying to operate in different ways, completely because Hancock wanted to be able to go on TV and say ‘look at me and my target I’ve hit’.” Cummings concluded. “The cabinet secretary told the PM that the British political system cannot cope with a secretary of state who lies repeatedly in meetings. We couldn’t get to grips with test and trace until we got it out of DHSC and into a separate agency.”

Nor did the prime minister escape the firing line: Cummings told the Covid-19 lessons learned committee that “after April 2020, there was no proper border policy because the PM did not want one. His argument was that lockdown had been a terrible mistake”.

He claimed that “the prime minister already is about 1,000 times far too obsessed with the media, in a way that undermined him doing his own job. It doesn’t matter if you’ve got great people doing communications, if the PM changes his mind 10 times a day, and then calls up the media and contradicts his own policy, day after day after day, you’re going to have a communications disaster… We cannot change our mind every time the Telegraph writes an editorial on the subject”.

Cummings confirmed that the BBC’s account of the prime minister saying he’d rather see “bodies pile high” than introduce another lockdown in the autumn was accurate: “I heard that: it was after the 31 October decision to lock down.”

Cummings added that “my relationship with the PM declined after the second lockdown in October, which he thought I blamed him for – and I did. The heart of the problem was, fundamentally, I regarded him as unfit for the job and I was trying to create a structure around him to try and stop what I thought were extremely bad decisions and push other things through against his wishes”.

We should of course bear in mind that so far Cummings has produced no corroborating witness statements nor documentary evidence. These are, as such, allegations rather than facts.

Hancock’s own testimony to the committee is likely to be quite gripping viewing, too. His friend and horse-racing chum, Conservative peer Baroness Dido Harding (ex-test and trace boss, newly returned to her NHS Improvement chair role) hit the news as a potential candidate to replace Sir Simon Stevens as the boss of NHS England.

Baroness Harding gave a combative interview to BBC Woman’s Hour defending the performance of NHS Test and Trace, claiming not to have read the negative media coverage and that expectations were set too high. “This year, we’ve learned that test and trace is part of the response, but not a silver bullet for return to normal. It’s not possible to do it with test and trace alone.”

The noble baroness also claimed in conclusion that she is “not a politician” and is “not here to campaign for something”. She is, of course, a Conservative peer, who within 24 hours appeared prominently in both the Sunday Times and on Woman’s Hour in relation to the chief executive vacancy at NHS England. Eyebrows might well raise.

Andy Cowper is the editor of Health Policy Insight

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