Andy Cowper: When an omnishambles meets Omicron

Missionary zeal from Boris Johnson cannot distract us from the realities of the crunch facing the NHS and the creaking social-care system
Photo: themostinept/Flickr/CC BY-SA 2.0

By Andy Cowper

14 Dec 2021


I wish all Civil Service World readers a happy Christmas, and the best for 2022. Having said that, I fear I may be about to bring you right back down, with the very real possibility that we’re going to end 2021 as we started it, which is to say in a pandemic lockdown.

The Omicron variant of Covid-19 has been proven to be considerably more transmissible than the Delta that has dominated in the UK for most of this year.

While it appears that those with three doses of vaccine enjoy over 70% protection against getting symptomatic disease, no vaccines are 100% effective. Add the 70% protection figure to this fact, and the transmissibility increase, and even if only a small percentage of people get ill enough with Omicron to require hospitalisation, that is a small percentage of a large number (the UK population) – which is a large number.

That large number of forthcoming hospitalisations will head into an NHS already stretched very near to breaking point. The latest national data shows a waiting list that is now almost at 6 million.

NHS Providers boss Chris Hopson’s informative Twitter thread gives a useful view across the piece for the NHS provider sectors. He notes that the “elective surgery waiting list has increased to 6 million (up 2.4% compared to last month). And the number of patients waiting more than 12 hours in A&E worryingly up to over 10,500 (the highest ever monthly figure and up 50% vs last month) … Bed occupancy at 94%, vs. last year’s 87%. Adult critical care occupancy likewise 81% vs 74%. Ambulance handover delays longer: %age of 30-minute-plus waits risen from 11% last year to 20% this year”.

Hopson concludes, “we should stop comparing Jan 2021 with Dec 2021. All the evidence suggests that NHS is under unprecedented pressure for this time of year”.

Will the NHS be getting better soon? The signs are not that encouraging: it is widely known that there is ongoing disagreement between the NHS and 10 and 11 Downing Street over finalising the “re-set and recovery” programme. Its publication, which Health Service Journal reported was due last month,  is fairly clearly pushed off into 2022.

The workforce shortages that are a root cause of much of the pressure in the NHS are also the subject of a 15-year Department of Health and Social Care plan, which health secretary Sajid Javid promised would be published “in the spring”. (We can only assume that he means spring 2022: those observing the government’s social care plans will know it’s worth asking “which year?”.) An amendment to the health bill now in the House of Lords that would have compelled regular publication of workforce plans and progress towards meeting them (promoted by former health secretary and Commons Health And Social Care Select Committee chair Jeremy Hunt) was voted down by Conservative MPs. It is clear from the Lords debate that the peers spiritual and temporal intend to try to reinsert this clause, and to remove the parts giving additional powers of intervention to the health secretary. One to watch for 2022.

Johnson adopts ‘national missionary position’

This is why Boris Johnson has just announced new targets for the vaccination programme – an “Omicron emergency booster national mission”. In his Sunday evening announcement, the PM told the nation, “a fortnight ago I said we would offer every eligible adult a booster by the end of January. Today, in light of this Omicron emergency, I am bringing that target forward by a whole month. Everyone eligible aged 18 and over in England will have the chance to get their booster before the new year”.

“National mission” is a classic example of the PM’s taste for rhetorical inflation. If it’s a national mission, then the government are VERY SERIOUS ABOUT THIS.

This administration’s track record on over-promised and under-delivered national missions is worth remembering: who among us has forgotten the promised yet un-delivered “world-beating” test and trace, or the 100,000 tests for a day episodes?

The PM is desperate to avoid any more lockdowns, hence this Hail Mary approach to increasing booster doses. For those who still believe in Santa Claus, perhaps it will seem plausible that the NHS, with the Army, can deliver a million vaccinations a day every day between now and the end of the month, when the very best day yet recorded saw under 850,000.

I mean, should we put our faith in a fat, implausible white-haired Caucasian male of Turkish heritage who doesn't exist in the real world, or in Santa Claus?

Reality intrudes

Unfortunately for the PM, reality has this inconvenient habit of intruding on his boosterism. On the day after this announcement, the government’s website has run out of supplies of lateral flow tests to be used at home. They had not, at the time of writing, even put up a “notify me when these are back in stock” option.

And this, when we have spent £37bn on test and trace (now part of the UK Health Security Agency). That is not a great start, to put it mildly.

The NHS website for booking booster appointments has been overwhelmed, and is asking people to try again tomorrow.

It gets worse, as The Times’ Whitehall editor Chris Smyth noted that the PM and NHS seem to define the new boosters target differently. Johnson promised all adults “will have the chance to get their booster before the new year”. The NHS “will offer every adult the chance to book”  by Dec 31 – with millions of jabs actually happening in January and February. The BBC’s Vicki Young confirmed this: “Department of Health sources clarify that the promise on boosters is to ‘offer’ them by end of December; not ‘deliver’ them”.

It’s almost as if the right hand doesn't know what the further-right hand is doing. This government’s evident competence deficit is far from reassuring. I have a feeling that the public mood is about to turn extremely ugly.

Ain’t no party like a tier 3 party

All of this comes on top of the government’s unforced political self-immolation over disgraced Randox lobbyist and former MP Owen Paterson’s parliamentary standards sanction.

That grotesque error was compounded by the revelation by ITV News that the illegal parties at 10 Downing Street last November and December were open secrets to the most senior people in the building.

There has been genuine public anger at 10 Downing Street holding a party on 18 December 2020 that was illegal under Coronavirus legislation in place at the time, as the Downing Street Twitter account confirmed on the day before.

Taking place when London was in tier 3 restrictions – the legislation for which can be read here – the party was well-known throughout Downing Street, and in particular by the PM’s then-spokesperson Allegra Stratton. Footage leaked to ITV News shows  Stratton laughing and joking with Downing Street colleagues about how they would handle media questions about the party. BBC political editor Laura Kuenssberg tweeted that party attendees told her they’d been invited to attend by Downing Street political staff, as well as by civil servants.

40-48 fictional new hospitals in ‘not on track’ shock

Attentive regular readers know that I have been banging on for some time about another huge issue for NHS capacity: the physical infrastructure and backlog maintenance, now standing at over £9bn in total cost. In the face of this, the government has been repeating its mantra/promise of 40 or 48 new hospitals (which are neither new nor hospitals: in reality, there are six rebuilds under way).

Imagine my surprise to learn from HSJ that the Infrastructure and Projects Authority downgraded the government’s fantasy nonsense about 40/48 new hospitals (which as I’ve been pointing out incessantly, is actually six) to a “red” risk rating of being delivered by 2030. The financial downgrading of capital redevelopment plans for submission was also spotted by HSJ earlier this year.

The ‘social don’t really care’ white paper

We finally got People at the Heart of Care, the new adult social care white paper, this month. Alas, it’s beyond indifferent. The Association of Directors of Adult Social Services’ recent snap survey portrayed the crisis in social care in realistic terms. The white paper is utterly inadequate to the many challenges.

Wise heads, such as that of Richard Humphries, make the best observations I’ve yet seen. The Institute for Government’s Graham Atkins also makes good points, and shadow care minister Liz Kendall’s Commons speech was a good one.

Health and Social Care Committee chair Jeremy Hunt called the white paper “a disappointment” given the extent of the crisis in social care and the predicament of people whose quality of life is dependent on a solution being found. “Providing an additional £1.7bn in funding over three years falls far short of the annual £7bn sum that our evidence found would be necessary to fix social care,” he said. “The white paper states that it provides an ‘ambitious ten-year vision’, but it doesn’t acknowledge the scale of extra resource needed to realise that vision, based on the crisis the sector faces right now.

“The government deserves credit for grasping the nettle of social care reform, and no-one can argue with the laudable aims of providing choice, quality and fair access. However, these plans represent three steps forward and two steps back. Though there is progress with a cap on care costs, it could have gone further. Failures in social care will continue to put pressure on our overstretched hospitals with patients who cannot be safely discharged exacerbating the winter crisis and thousands of people will not get the care they need because the carers do not exist.”

Towards 2022

This has not been a quiet year in health and social care (are they ever?), and 2022 won’t be one either.

Outside the pandemic, the new year will bring us the Messenger Review into NHS leadership; the promised NHS “re-set and recovery” plan and the DHSC 15-year workforce strategy; the later stages of the health and social care bill; and the local elections in May, which will not only reflect on the government’s popularity but also affect the political complexions of local government, with its responsibilities for social care and precept-setting to help fund it.

Have a good festive break, everyone. You’ll need it.

Andy Cowper is the editor of Health Policy Insight

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