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I would like to introduce you to a Member of Parliament.
A fine upstanding person you may have no doubt and Knighted into the bargain.
By dint of a survey, at one time he held the distinction of being the ‘the worst MP’ in the People Power Index… make of that what you will.
He also got himself into a bit of bother at the 2019 Tory Party Conference where he had a ‘dispute’ with the security people after he tried to enter a meeting room with a guest who had no security pass... and got chucked out.
Our man said it was a minor 'verbal misunderstanding’… whatever that means.
During the parliamentary expenses scandal in 2009, our hero switched his main residence from his house in the Cotswolds to a London flat… all within the rules, of course.
So, there you have the Member for North Cotswolds, Sir Anthony Clifton-Brown. The chairman of the Public Accounts Committee who have just published their first report… into the NHS.
It’s a stinker. Inaccurate, lazy, full of let’s say, misunderstandings and in my opinion gratuitously insulting.
It is an unwarranted attack on the people struggling to make sense of running NHSEngland in the most difficult of times...
... made worse by the fact that one of the committee members is Angela Dixon MP., formerly of the King’s Fund who will well know what a calumny this is.
I can sort of forgive a fellow old duffer who has trouble understanding where his home is, or that he needs a ticket for a high security event (it could happen to the best of us) but not Dixon who knows the system inside out.
The NHSE people who appeared at the committee hearing did so in advance of the agreement, signing off and publication of the NHS England 2025/26 priorities and operational planning guidance.
Hence they would have been unable to reveal exactly what their forward plans were. Dixon would have known that.
DH+ budget settling has been dysfunctional and has become even worse in recent years. Compounded by planning guidance being made available only a few days before the start of the year... see the graph below.
Dixon would have known that.
‘Short-termism’ and ‘dysfunction’ in financial planning, identified by Mr Brown’s Boys and girls, has nothing at all to with NHS England who constantly struggle to make one pound do the job of two, whilst trying to make strategic sense of Streeting’s childlike strategy, to declare ‘everything is broken’.
'Unwillingness, unpreparedness, unreadiness’ for change is the accusation.
Wake up, numpties…
... there is no plan, no blueprint to be ready for. Labour’s ‘Plan for Change’, due in ‘the spring’, is bogged down and been quietly slipped to summer.
To suggest that health chiefs in England are complacent and lack the drive to transform the NHS is not only balderdash, it ignores the reality;
- the NHS is doing 7% more work than before Covid,
- it’s productivity outstrips the wider economy with
- fewer managers than comparable industries and
- fewer nurses, doctors, kit-n-caboodle that any other comparator health system,
- in buildings that are falling down, with
- primary care that survives on a pittance, in an
- estate, half of which is not fit-for-purpose.
All the result of criminal underinvestment by a succession of delinquent, politicians that called themselves governments.
There have been 8 health secretaries in the last 120 months.
If we had a government, any government, that knew what it wanted I’m pretty sure the NHS would roll up its sleeves and get on with it.
That is not to say I cannot see, if Labour ever publishes a reform package, a major problem.
Bandwidth…
… the capacity to handle both the demands of day-to-day operations and the challenges of change.
The NHS has always been expected to deliver change whilst struggling with the day job.
In this case, a winter surge that started in the autumn and looks like it might head for spring and waiting lists, that are coming down but capacity and headroom limit real headway.
Work-rate, cognitive load, and organisational support influence manager’s ability to absorb change while improving operational performance. Add to that political uncertainty and it makes it an impossible task.
The PAC’s illiterate attack on NHSE shows an ignorance that undermines their authority and any hope they might be taken seriously with other reports in the future.
The public accounts committee is a crucial assembly that needs to show judgement, restraint and a deep understanding of government, its machinery and timing.
They do not exist for point-scoring, showboating or grandstanding.
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