Andy Cowper: A new NHS chief exec, and a personal responsibility lecture from Boris Johnson

The PM has gone ahead with the Covid unlocking, but the new health secretary had to go nearly straight into isolation after testing positive. Sajid Javid also got to grips with his in-tray, including appointing a new NHS chief
New NHS England chief exec Amanda Pritchard with health secretary Sajid Javid. Source: Sajid Javid via Twitter

By Andy Cowper

30 Jul 2021

As the UK surfs the third wave of Covid-19 to a soundtrack of “pings” from the app, it’s been hard not to detect the end-of-term vibe in the political world as parliament finally wound its way into recess.

It’s been quite a month-and-a-bit. At one very special Downing Street briefing, the prime minister presented the nation with the most spectacular false binary choice you’ll see this year over the plan to end all of the Covid-19 stage four restrictions on 19 July.

“If not now, when?” has become the prime minister’s replacement for “data, not dates”.

Magnificently, the PM with a peerless reputation for betraying people and lying also gave out about the nation’s need to move to “personal responsibility”. A prime minister whose own sense of personal responsibility couldn’t be found with nanotechnology urged the country to show personal responsibility and caution.

It would be fun to believe that Johnson’s premiership is an exercise in seeing just how far you can take irony, but he’s genuinely not that clever.

Enter ‘The Saj’

New health and social care secretary Sajid Javid took over, following the spectacular self-immolation of Matt Hancock (who actually tried to stay on once he’d been found out shattering his own pandemic rules by conducting his affair during work time, in the office, with an employee. Even more amusingly, the PM tried to let him do so).

The Saj’s position on the more economically dry wing of the Conservative Party could make the run-up to the next spending review interesting (he is such an Ayn Rand fan that he reads a scene from a film based on her books every year).

Certainly, The Saj’s health consequences hit the headlines when he got Covid-19 and had to self-isolate. This gave us the beautiful spectacle of perhaps this government’s fastest U-turn yet, as No.10’s initial effort to pretend that the PM and chancellor (both in close contact with Javid at a long meeting the day he tested positive) could avoid having to self-isolate because they’d been randomly picked as members of a “special testing scheme” were reversed in under three hours following huge public outcry. (No, you wouldn’t know this special testing scheme: it goes to another school.)

Do U-turns matter? Well, Javid’s Harvard thesis from December 2020 stated that in a pandemic, U-turns are an “essential feature of good policymaking”. He wrote “for the politician, the tendency for decisions to become psychologically and emotionally anchored in identity makes U-turns so difficult – we are wired to stick to our guns… making U-turns easier is important, and can be made easier through a focus on storytelling, on reframing, on articulating its commonality in other contexts (eg business), and on its healthy role within democracies.”

We shall see.

Javid has plenty else on his plate beyond the pandemic. The latest NHS performance statistics are ugly: there were 1,436,613 attendances at major A&E departments in June 2021, 102, 476 (7.7%) more than the 1,334,137 visits in June 2019. The waiting list for consultant-led elective care reached 5.3 million by the end of May 2021, an increase of 182,832 from the 5.12 million patients waiting at the end of April 2021.

A total of 336,733 of those waiting had waited over 52 weeks at the end of May 2021, compared to 385,490 at the end of April 2021. 1,728,981 (32.6%) of patients on the waiting list had waited longer than the 18-week standard by the end of May 2021, compared to 1,811,899 (35.4%) by the end of April 2021.

Meanwhile, it has been confirmed that departing NHS England boss Sir Simon Stevens – now Lord Stevens of Birmingham – will be replaced by his deputy, NHSE’s chief operating officer Amanda Pritchard.

The unbearable triteness of Cummings

The NHS was a mainstay of the latest round of the self-publicity roadshow of the PM’s ex-chief adviser Dominic Cummings: a man whose farewell tour duration could put Dame Nellie Melba to shame.

In his interview with BBC political editor Laura Kuenssberg, Cummings addressed Vote Leave’s misleading £350m NHS bus claim, he started to grin, and grin, and grin some more with evident self-satisfaction. “I wouldn’t say we used it misleadingly”, The People’s Dominic grinned, going on to say “we used true figures”. Grin, grin, grin. You got the sense that he’d cuddle himself if he could.

The interview moved to the subject of Boris Johnson’s (lack of) character and suitability to be PM, especially as regards the pandemic. There’s something darkly funny about the delayed realisation that was on show here: Cummings on the real nature of Johnson (utterly unfit to be anywhere near power); Kuennsberg’s on the real nature of Cummings (ditto) – Cummings was, of course, Kuennsberg’s principal source during his time in 10 Downing Street advising the PM.

Things get thoroughly sinister when Cummings grins, “we were planning to get rid of him (Johnson) as PM and replace him within days” of the 2019 general election. It’s quite a thing that this person was at the very centre of government for a year after the general election.

Social care – still no plan

Social care has had its time in the political sun over the past few weeks. Sadly, the conversation’s been all over the place like a startled rabbit.

The government’s internal arguments over social care reform have prompted so many leaks over the past fortnight that we’ll be on for a drought, even after the flash floods that have hit London.

The Times front page led with the report that national insurance will rise by 1% (employers’ and employees’ contributions) to fund health and care.

National insurance is, of course, the tax that retired people specifically do not pay any more. This is getting baroque. (And of course, social care is not just for older people with dementia care needs, but that’s the bit the public may slightly understand.)

So, 1% on NI to fund health and care. Mmm… where have I heard that before? Ah yes... they’ve reached the “New Labour tribute act” stage of the political cycle, then.

The Times’s Steven Swinford reported that “the new health and social care tax will initially be used to address the NHS backlog following the pandemic”. And then after that, it will pay for whatever social care reform may be coming.

The Spectator’s Katy Balls shares a shares a nice anecdote in a piece for the i, revealing that Johnson’s July 2019 vow on becoming PM that “we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve” landed as such a surprise to the Department of Health and Social Care hierarchy that one special adviser (at that moment, in the lobby of the House of Commons) ran out of parliament and spent the day in hiding to avoid journalists’ questions about it.

As if by magic, later that day the Guardian reported that the proposals cannot be expected before the autumn, because Johnson, Sunak and Javid cannot agree the deal to be done by Zoom. What a mess. 

Andy Cowper is the editor of Health Policy Insight, where he writes the weekly “Cowper’s Cut” column.

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