Health Week Two: The Saj rides to the rescue

Health columnist Andy Cowper looks back on the return of Health Week, assesses the latest review of NHS leadership, and looks for information on the promised 40-new hospitals
NHS banner. Photo: themostinept/Flickr/CC BY-SA 2.0

By Andy Cowper

14 Jun 2022

Last December’s government "Health Week" (social care white paper, a dribble of cash for winter and a winter policy paper) was clearly such a triumph that they repeated the trick by giving us a sequel in June.

Could events overshadow this encore? 

Oh yes: indeed events could – and did. 

Prompted by a plethora of scandals and screw-ups ranging from Paterson to Partygate, prime minister Boris Johnson faced a leadership vote of no confidence from his own Conservative MPs, in which 211 of them supported the PM. The 148 Tory MPs who voted no confidence in the PM's leadership represent 41 per cent of the MPs whom Johnson led to a big electoral victory in December 2019.  

Johnson's vote of no confidence was a proportionately bigger share of his MPs than those who voted against John Major in 1995, or against Theresa May in 2018. It matched the proportion who voted against Margaret Thatcher in Michael Heseltine’s 1990 leadership challenge. 

The prime minister is clearly holed below the water-line by this result. He may not sink fast, but he will sink. Having over 40% of his MPs vote against him mid-parliament is as dire as it is irrecoverable. 

Blue-on-Blue fire 

Health Select Committee chair Jeremy Hunt (runner-up to Johnson in the last contest, and seen by betting markets as leading the odds to succeed this time, as a "clean-skin") set out his change of mind why now had become the right time for a change of party leader in this series of tweets. 

Mr Hunt was instantly and vitriolically attacked by Mr Johnson's joint-biggest fan: culture secretary Nadine Dorries. (The Times  reported that this attack was authorised by Downing Street.) 

This Blue-On-Blue firefight saw Dorries –  a cabinet minister, remember – claiming that the government did not prepare properly for the pandemic. The Covid-19 public inquiry may wish to pursue this allegation, especially as Dorries was a health minister responsible for patient safety during the pandemic. 

"A Blockbuster system in an age of Netflix" 

We learned that health secretary Sajid "The Saj" Javid had told the cabinet that the NHS was “a Blockbuster system in an age of Netflix”: a remarkable metaphor that leaves us neither wiser, nor better-informed. Was it a reference to Netflix’s huge debts, or loss of paying subscribers? Javid could not explain what he meant by it; nor could the PM's official spokesman, who relayed it to lobby journalists. 

Still, now we can make up our own Saj-isms about the NHS: “a ventouse service in an age of chrome”; “a son et lumiere service in an age of ABBAtars”; “a weltschmertz service in an age of schadenfreude”; “a Spaghetti Western service in an age of Love Island”. Minutes of fun to be had there. 

Messenger shoots straight, but gets played on the launch 

General Sir Gordon Messenger’s NHS leadership review arrived in Health Week, and contained most of what was briefed to Heath Service Journal back in April. 

The Saj sought to retail this report to Parliament and the media as "a once in a generation shake-up of management, leadership and training". A generation? Perhaps The Saj meant a generation of gerbils. Recent NHS leadership reviews –  the 2018 Kerr Review and the 2015 Rose Review – came to many of the same conclusions as this one: nothing improved as a result. 

The Messenger review’s seven recommendations aren't wrong. Nor were they wrong on any of the previous occasions that NHS leadership reviews found them. This one suffers from an acute lack of 'how', providing neither theory nor practice of how NHS leadership will be helped or incentivised to improve. 

The review is politely damning about national and political NHS leadership: "the sense of constant demands from above, including from politicians, creates an institutional instinct, particularly in the healthcare sector, to look upwards to furnish the needs of the hierarchy rather than downwards to the needs of the service user. 

"These pressures inevitably have an impact on behaviours in the workplace, and we have encountered too many reports to ignore of poor behavioural cultures and incidences of discrimination, bullying, blame cultures and responsibility avoidance. 

"… These symptoms are not, we would observe, necessarily the fault of historical or existing leadership teams or their staff. They are the result of a combination of factors over many years; some structural, some cultural, some emanating from behaviours at the top, including politicians, some born of complex inter-professional and status issues in the workplace”. 

It's spot-on. And it's instantly clear why the Department of Health But Social Care issued a press release on the afternoon before its launch which featured none of this. It worked, too: the national media just covered that press release, and The Saj's empty rhetoric, and did not go back to look at this. 

The DHSC leadership couldn't have people paying attention to their actual conclusions, of course: they were directly in the line of fire. So they didn't shoot the Messenger, but they sure as hell played him. Ironically, this makes the General’s point about political, defective and deflective system leadership perfectly. 

Enough money, not enough workforce 

As if this weren’t enough Javid for one Health Week, The Saj gave this interview to  The Times  in which he claimed “the NHS now has locked in the resources it needs. It doesn’t need any more money. What it needs to deliver for more people is not money: It needs reform.” 

Sadly, The Saj didn't go on to explain what the necessary reform would look like, nor how it would work. 

He also gave evidence to the Commons Health Select Committee’s workforce inquiry. Chair Jeremy Hunt asked The Saj when the Framework 15 (years’ timescale) workforce plans will be published. After some game waffling, The Saj promised that it will be before Parliament's summer break. F15 will not give numbers, Javid cautioned: it will be about drivers; skills; behaviours; use of tech; how disease has changed. 

Pah. Who needs anything as basic as numbers? 

Yet Hunt persisted, and The Saj said that NHS England's workforce strategy would produce numbers by the end of the year. 

He didn't specify which year, of course. 

What do the workforce themselves say? GP magazine Pulse reported its new survey's findings that 47% of GPs plan to retire before the age of 60. Of those who intended to retire at or before the age of 60, 12.5% planned to bow out before reaching 55. GPs suggested that this trend was driven by “intense workload and workforce pressures”. 

The international recruitment situation has become ugly: GMC data obtained by FOI shows that the NHS is for the first time hiring more doctors from outside the UK and EEA than from inside. 

The Fictional Forty ‘new hospitals’ attract NAO attention 

Labour's health lead Wes Streeting called for a National Audit Office review of the Government's plan for 40/48 fictional new hospitals. It seems that the NAO is indeed preparing such a review: it’s suggested that this was already in progress prior to Streeting's intervention. 

What may prove a more powerful intervention is former NHS England boss Lord Stevens of Birmingham's tabling of a written Lords Parliamentary Question, asking "Her Majesty's Government what is the (1) planned construction start date (2) expected construction completion date and (3) budgeted cost for each of the 40 new hospitals they propose to build by 2030". 

Lord Kamal's eventual answer should be quite funny. 

Andy Cowper is the editor of Health Policy Insight 

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