Andy Cowper’s insights on Hancock’s most remarkable speech featuring “seven lessons” for the NHS and the “future of healthcare”.
Andy Cowper’s insights on Hancock’s most remarkable speech featuring “seven lessons” for the NHS and the “future of healthcare”
A huge amount of really significant things happened this last week: I will have to come back to many of them. But the record needs a quick summary of the key issues.
There was the story briefed to The Guardian about moving responsibility for social care into the NHS (which looks like it comes from the advisor involved, Camilla Cavendish); the PAC described the government’s preparations and performance during the pandemic as “slow, inconsistent and negligent”; the Health Foundation looked at adult social care and covid-19; and the government U-turned on the promised regular coronavirus testing for care homes.
However, this week’s column must be about the most remarkable political speech in UK politics of recent years. It is not remarkable in a good way, and you will not be surprised to hear that it was given by health and social care secretary Matt Hancock.
Longstanding readers will recall the previous health and social care secretary, functioning political grown-up Jeremy Hunt, gave the October 2015 HSJ Annual Lecture on very much the same theme.
It is instructive to consider and compare how crisply Mr Hunt marshalled his argument as he described the four “bear-traps” the service must avoid (too much bureaucracy, a lack of accountability, rising costs and poor data security), before concluding with an emphasis on the importance of NHS culture.
Mr Hunt built that argument on his July 2015 speech, which talked of “making healthcare more human-centred and not system-centred” and claimed “the transition to patient power will dominate healthcare for the next 25 years.”
Mr Hancock’s speech cites “seven lessons” the service has yet to apparently fully take on board. They are:
- Value our people
- Bust bureaucracy
- Better tech means better healthcare
- About open borders
- No trust is an island
- Accountability matters
- The nation’s health is bigger than just the NHS
This is not an original or coherent vision of the future of anything, it is simply a purloining of Jeremy Hunt’s ideas based on his successor’s (then) three years as health secretary, mixed with a retread of the broad themes of Sir Simon Stevens’ post-Lansley reforms, garnished with some NHS management clichés and topped off with a helping of motherhood and (low fat) apple pie.
Mr Hancock has not been health secretary for three years: it just feels that way. It is two years now, and he appears, to borrow Jacques Godechot’s famous line about the Bourbon monarchs of France, to have “learnt nothing and forgotten nothing”.
Politicians have made bad speeches before – and will do so again. What makes Mr Hancock’s especially hard to bear was his use of analogies and language which ranged from the cringe-inducing to the misguided.
The rhetoric is as embarrassing as the logic at many points. Mr Hancock claims that “like sheet lightning on a dark night, it (covid-19) has suddenly and dramatically revealed our healthcare landscape in a way that we’ve never quite seen it before. We’ve discovered things about our system that we could not have learned in normal times.”
The idea that covid-19 has delivered unique lessons is spurious. You could have learned all you need to know about the austerity-buffeted NHS’ resilience in the face of increased and intense demand every winter (and indeed, recently, most summers too). What has been different about the pandemic period is that the government has spent hand over fist to keep crisis at bay. This is probably not a “lesson” that Mr Hancock would wish to promote.
Nor have we genuinely learned anything new about which bits of the NHS system are genuinely value-adding or redundant. Mr Hancock indulges in some common-or-garden bureaucracy-bashing, which as usual, fails to offer any actual examples of redundant bureaucracy.
Mr Hancock claims the NHS achieved a “doubling (of) ICU capacity to treat the most sick”: HSJ readers know perfectly well that there was no such doubling. ICU staff were simply spread more thinly, supplemented by crash-trained professionals from elsewhere in hospitals, while elective care was halted to free up beds.
It was an impressive achievement, and it prevented the NHS being obviously overwhelmed, but it was not a doubling of ICU capacity: ask any clinician who works in that area.
Mr Hancock tries to claim that, just as “they say there are no atheists in a lifeboat. Well, there are no ideologues in a pandemic.” Well, they don’t say “there are no atheists in lifeboats”: the aphorism is “there are no atheists in foxholes”. (Wikipedia also given us the picture of the phrase as deriving from Jeffrey Frankel’s “Perhaps then, there are also no libertarians during crises”).
The health secretary, in an heroic feat of chutzpah, also raises the issue of tech in healthcare while ignoring the unmitigated failure of the covid-19 app, and the massive ongoing problems with the fitness for purpose of NHS TAT.
It is a depressing sign of the times that nobody in the Department Of Health But Social Care pointed any of this out to The People’s Partridge. It may be that DHSC staff and advisors have spotted Mr Hancock’s role as the government’s designated “Covid Colt Seevers”, and do not wish to intrude on private career grief.
Nothing about how
If the title of your speech is “The Future Of Healthcare”, then your audience would reasonably expect that you are going to describe that future and set out how the NHS is going to get there. Mr Hancock did not do this. It is best understood as a massive “who, us the Government, guv?”: the political speech equivalent of “the dog ate my homework”.
It seeks to portray the covid-19 crisis as utterly inevitable (which is was not as the government was empirically slow to lockdown), and the NHS response as heroic and successful. The NHS response saw huge heroism (particularly during the early weeks when PPE was in short supply), and there were successes, but the idea that the NHS was protected is not correct. It was not overwhelmed. As Mark Britnell pointed out, writing for HSJ this week, these are two distinct things.
Meanwhile, social care remains the poor relation. Mr Hancock says only “now it’s time to set clear ambitions about the future of social care in this country and fix an issue that has been ducked for far too long”. Set clear ambitions? Now we’re really reassured.
The only hint of “how” Mr Hancock’s vision will be achieved is in the lines which suggest future health and care reform will be approach at a system level and that this “will include a financial and inspection approach that encourages and rewards collaboration.”
Anyone who has been paying the remotest bit of attention will know that this has been the direction of travel long before Mr Hancock arrived on the scene.
So why make the speech?
Mr Hancock’s “who, me, guv?” approach is unlikely to fool many HSJ readers. His speech about ‘the future of healthcare’ is in reality an attempt to move the focus from the UK’s unenviable Covid death toll.
But perhaps I am being too unkind. Mr Hancock says at the end of his speech that it makes “the start of the conversation, and I want to hear what you think too … I want to discuss what works and what matters to you”. So this speech about ‘the future of healthcare’ is really just a natter. A chat. What else would one expect from The People’s Chat Show Host!”
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