Andy Cowper: The PM plays party games while the NHS strains under Covid pressures

The PM’s non-apology on the “BYOB” No.10 garden party won’t convince many. Meanwhile, NHS workforce and waiting list challenges remain
Photo: Paul Edwards/Pool via REUTERS/Alamy stock photo

By Andy Cowper

19 Jan 2022

If you were in government during a pandemic of a fatal new respiratory disease like Covid-19, you’d want your citizens to take you seriously when you advised or ordered them how to live to cut the risk of infection and death.

This means that you’d want to stick by your own rules and recommendations: maybe even set an example. That’s the obvious theory.

It seems that this has not been obvious to the current administration. The past month has seen a wave of further revelations about parties in Downing Street and Whitehall which clearly broke the rules during the periods of lockdown restrictions.

ITV News obtained emails showing that in May 2020, at the time permitted meetings were limited to two people outdoors, 100 Downing Street staff were emailed and invited to a "bring your own booze" party.

This email was sent by the prime minister's principal private secretary Martin Reynolds to over a hundred employees in No.10, including the prime minister's advisers, speechwriters and door staff.

The PM’s allegation that he didn't know about or see the invitation to the BYOB Downing Street Garden Party was undermined in Dominic Lawson’s Sunday Times column, which cites “a former Downing Street official who said at least two people had told the PM, after seeing the emailed invitation from his principal private secretary, Martin Reynolds, that this was 'a party' and should be immediately cancelled. I was told that Johnson’s dismissive response was to say they were 'over-reacting' and to praise Reynolds as 'my loyal Labrador'.”

The PM’s repeated denials that he knew the Downing Street BYOB party was a party came under similar attack from his former chief adviser Dominic Cummings, who tweeted that Johnson “knew it was a drinks party, he lied to parliament”.

The flag-worshipping party disrespects the Royal Family

Probably the most damaging was the subsequent revelation of two separate parties in Downing Street the night before the burial of the Duke of Edinburgh, a situation which forced No.10 to apologise to the Queen.

Alongside this, we learned that Kate Josephs, the former head of Covid rules for the government, held a boozy leaving party in Whitehall during lockdown.

It was also revealed that the PM and has wife appear to have repeatedly violated travel regulations to move between Downing Street and Chequers during lockdown.

PMQs, and the non-apology apology

“Mr Speaker, I want to apologise”, PM Boris Johnson told the Commons at the following Prime Minister’s Questions.

He then didn't, obviously and repeatedly.

The PM’s defence had evidently been legalled to within an inch of its life: “when I went into that garden just after 6 o’clock on 20 May 2020, to thank groups of staff before going back into my office 25 minutes later to continue working, I believed implicitly that this was a work event, but with hindsight, I should have sent everyone back inside... I should have recognised that even if it could be said technically to fall within the guidance, there would be millions and millions of people who simply would not see it that way”.

The wording was also telling during Labour leader Sir Keir Starmer’s questioning: the PM said “I have and will continue to apologise for what we did”. Note the use of “we”: Johnson is looking for others to blame.

The PM was evidently advised by his lawyers to reach for a defence based on his belief about the BYOB party – sorry – work event: “I accept that we should have done things differently on that evening. As I have said to the House, I believe that the events in question were within the guidance and were within the rules … my apology for all the misjudgments that may have been made – that were made – on my watch in No.10 and across the government”.

This is a theological defence. Johnson hopes that someone, somewhere, will buy the concept that his belief that a “bring your own bottle” party is a work event may have protected characteristics.

Conservative Party chair Oliver Dowden (who reiterated the rules on the televised Downing Street briefing just nine minutes before the start of the infamous event) attempted to tell BBC1’s Sophie Raworth on the Sunday Morning show that the “underlying culture” in Downing Street had fed into Partygate.

What nonsense. The problem with the Johnson administration is the lying culture, not the underlying culture.

According to the reliable Paul Waugh of the i, after PMQs, the PM toured the Commons Tea Room telling Conservative MPs that the BYOB party “was not his fault” (he wasn’t sent the invite) and he was “taking the blame for others” (ie. civil servants and special advisers)”.

The PM’s self-preservation plan – Operation Save Big Dog, according to The Independent – apparently involves laying down the careers of junior Downing Street staff and civil servants for Johnson’s political life.

Greater love hath no woman or man: I’m sure they’ll all be bang up for that. What could possibly go wrong?

Watching a party of government negotiating this novel mash-up between Stockholm Syndrome and a circular firing squad is certainly a bracing way to do national politics.

The effects on the workforce

The mathematics of Omicron infections’ exponential growth hit the health and care workforce hard: last month, The Sunday Times reported that almost 10% of the workforce were off sick on New Year’s Eve. Of these 110,000, nearly half – 50,000 – were absent due to Covid-19.

Health Select Committee chair Jeremy Hunt predicted that NHS workforce issues will get “increasingly severe” this year, causing unprecedented stress on hospitals and GP surgeries, with “extremely concerning implications for care quality and safety in 2022”.

It is now clear, as the Royal College of GPs briefed the Guardian, that the targets on primary care recruitment of 26,000 extra staff are almost certainly going to be missed. This excludes the much-vaunted 6,000 extra GPs promised in the 2019 Conservative manifesto.

HSJ’s Nick Kituno reported on the GMC’s cancellation of exams to enable overseas doctors to qualify to practice in the NHS, due to pandemic workforce shortages.

The Guardian published some important pieces on workforce exhaustion issues. Firstly, this set of interviews with staff at Royal Preston Hospital; and then this important piece based on a survey from the Medical Defence Union about the rates of fatigue among doctors.

Staff fatigue and exhaustion is a real problem. This might get overlooked in the wake of Partygate, but it shouldn’t. It’s really important. The whole NHS “not overwhelmed” nonsense is obscuring real risks to the ability to deliver safe care.

Privates on parade: in extremis and not overwhelmed

There was oddly little coverage (with CSW a notable exception) of the decision by NHS England Pope Amanda Pritchard to request ministerial direction from health but social care secretary Sajid "The Saj" Javid’s mandating of the NHS to buy capacity from the private sector on what looks very much like the old independent sector treatment centres “take or pay” model.

The Saj emphasises that this must only be done “in extremis”, which is ever so reassuring and clear as definitions go. It’s about as helpful as “unsustainable”.

Pritchard is being smart. To the best of my awareness, no previous NHS England chief exec or commissioning board has requested ministerial direction.

There are a few problems with this strategy. The main one of them is the lack of clarity that this capacity actually exists in the private sector.

Anecdotal evidence tells me this putative capacity does not, in fact, exist. Similarly, I’m hearing that NHS doctors who formerly did a little private work on evenings and weekends to practice lower-intensity medicine with “nicer” patients in pleasant settings with proper admin support have begun to stop doing so. A common cause for this is that the NHS meltdown has pushed far sicker people into the private system, making the work as stressful and high-stakes as their NHS practice.

Another is that private sector rates for insured work have not risen as much as these people would expect.

Waiting times worsen – again

The latest NHS England data shows a further deterioration of waiting times, with the figure moving over six million. The interruptions due to the Omicron wave will of course make this figure grow yet further in February. It’s also worth re-reading the Institute for Fiscal Studies’ December 2021 Where are all the missing hospital patients? report.

Health Service Journal’s James Illman and Matt Discombe analyse the data, and note that the top-line increase of two-year waiters by 15% is of major importance.

This comes on top of another leak to HSJ revealing that “the number of patients who waited 12 hours or more in an emergency department, from decision to admit to being given a ward bed, increased by around 15 per cent in December, compared to the previous month”.

In a stunningly foolish move, HSJ spotted NHSE guidance that people who refuse to vacate NHS beds for offered short-term step-down care should be threatened with legal action.

This is likely to age about as well as the infamous NHSE “immediately stop all ambulance handover delays” guidance. Ironically, NHSE press-released their latest ambulance data with the headline “Record number of NHS ambulance call outs for life-threatening conditions in December, despite jump in Omicron absences”.

Because when a system is under enormous and sustained pressure, more shouting at people to do the obvious but unresourced thing always helps.

Not so much test and trace, more ‘trace a test’

Pre-Christmas announcements from ministers (prime and sub-prime) focused on individual caution and regular testing, before a late segue into mentions of ventilation and meeting outdoors wherever possible.

The slight problem that arose here was about the lack of available testing. With £37bn budgeted to be spent on NHS Test And Trace, you’d think they’d sorted this one, wouldn't you?

And you'd be wrong. Indeed, Javid talked about having to “constrain” the system of supply over the coming fortnight, which included the return of schools.

Data expert Ankur Banerjee explained the causes of UK’s parlous testing availability situation in this enlightening Twitter thread. The key issue is that “all of the distribution is being handled by a single company which will be closed for 7-8+ days around Christmas and New Years' Eve, and therefore shortages will persist”.

Banurjee also picked up on why pharmacies (a principal pillar of test distribution) have only been able to order one carton of tests per day.

So on top of poor availability of self-tests, this would be a remarkably bad time for testing to screw up, no?

Oh dear. The Sunday Times’ Shaun Lintern reported on a leaked UKHSA document showing a secret backlog of 25,000 Covid PCR pillar 2 tests, affecting 4,600 care homes and 70 prisons across the country

“UKHSA said the backlog was cleared by Thurs night...but the briefing that warned of it was sent Friday/Saturday,” Lintern wrote.

This is Just Not Complicated Stuff. Operational mistakes are going to happen when a new wave of a pandemic kicks off, and people will understand that – but you look like absolute idiots if you deny or try to downplay them.

As UKHSA did.

The People’s Government has proven curiously unwilling to put in the effort to release everybody’s favourite noble Baroness Dido Harding of Winscombe’s diary of meetings with potential test And trace suppliers during her tenure of that organisation, as the Mirror revealed.

Good news

It’s a relief to be able to end with some good news.

The recent national data dashboards have been showing small declines in the seven-day hospitalisation rate (the seven-day rate fell by a few percent a day over the past few days at the time of writing). This may signal the peak of the Omicron wave – although it's worth remembering that more demanding infections from the return of schools, transmittting their way up into older and more vulnerable populations, probably lie ahead.

Let’s also remember that there are still almost as many people in hospital with Covid-19 now as there were during the first wave.

And let’s remember that the government’s plan for dealing with the NHS backlog – which the health secretary promised by the end of November 2021 – is still not here.

Andy Cowper is the editor of Health Policy Insight

Join CSW's sister publication The House on Tuesday, 25 January for the Reforming Health & Social Care online conference and explore the key elements of the health and social care whiteh paper and what it means for both primary and secondary care, patients and external partners in the health economy.
Register to attend visit: https://www.thehousebriefing.co.uk/event

Read the most recent articles written by Andy Cowper - Health Week Two: The Saj rides to the rescue

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