The Friday Blog: Prisoner, COVID Tier Three
Hello again, and my most sincere thanks to David Button who I thought filled in simply splendidly last week. As he mentioned, I had the very great pleasure of working with David and his colleagues at Cavendish Advocacy during the recent Conservative Party Conference, where I shared a platform with International Trade Minister, Greg Hands. I look forward to future collaborations and welcoming David back to share your 4 o’clock Friday cuppa at some point in the future.
But otherwise, Jeez. I go away for a couple of days and what happens? I spent some of my free time last Thursday enjoying a long walk on a beautiful, clear, crisp autumnal morning, which I managed to spoil for myself. I made the, frankly ridiculous, mistake of taking my headphones and listening in to Matt Hancock outline arrangements for the new tiered restrictions, a speech during which it felt like he used the term “epidemiological evidence” about 15 times. During two hours of what should have been calm, fresh air and exercise and quality thinking time, I just got more and more angry.
As was almost 100% predictable, the whole thing was a shambles from the outset. It started with Her Majesty’s Government receiving a serious ticking off from the Speaker of the House for making the plans public, before, as protocol dictates, Parliament was informed. But this is Boris Johnson’s Government, and it cannot even stick two fingers up to the Commons with any aplomb. As was almost 100% predictable, within moments of the offending web page going live, it crashed. Mr. Speaker had, almost, the last laugh.
So, let us get this out of the way upfront. Yes, I am seriously ticked off about being in the Tier Three West Midlands, but no, I am not going to relocate us home to Cornwall for the duration. Birmingham is where we have spent all of this, and this is where we will stay. That does not, however, mean that my anger at being a victim of this government’s increasingly wobbly logic, is any less justified. My main sympathies go to those, and I know two of three read this each week, who live in rural idyls deep in the heart of the Garden of England. You can probably look up from your screens across a village green to a dark and empty Pub, whose chances of ever reopening have just been dealt a savage blow. You are probably wondering what it is all about. What it is about Men of Kent, or Kentish Men, depending, is that you are taking a very big one for Team Boris. The political optics of all this are bad enough as it is, without the map of red Tier Threes mirroring exactly that of the Red Wall that the Tories were so proud of breaching at the last election.
You Londoners can get all smug on me again. Despite living in a city where rates were consistently rising, in some Boroughs more quickly than anywhere else in the country, you somehow managed to make Tier Two. Please enjoy visiting all the restaurants that are e-mailing to tell me that they have reopened.
If you are in Greater Manchester, where rates were consistently falling, in some Boroughs more quickly than anywhere else in the country, all I can say is keep the faith with little Andy Burnham. Standing up to bullies is the right thing to do, it just might not always feel like it at the time. And so, to us here in the Second City. If tough restrictions are needed, so be it, and both Sandwell and Dudley (just stop it with those silly accents will you) have remained consistently in the top 10. Just lock us down. But do it in a way that might be vaguely consistent and make sense to anyone possessing of half of one brain cell. Here is the thing, I can, right now, get up from where I am, walk down the hill into Hampstead Village, get on a bus or a train with a lot of other people, and travel in to the city centre. There, I can pay a carefree visit to the world’s largest Primark store. If you have ever visited a Primark store, you know what it will be like. All hand to hand on the Sale Rail and full contact at the tills. I can stay there as long as I like, marvelling at the number of people choosing not to wear face coverings. Yet, I cannot recover with a beer and a burger at the Weatherspoons across the street. I am not instinctively a fan of the ‘spoons, but I do have to say that they were well ahead of the game in devising an App that actually worked, and allowed me to walk in, find a table and order food and drink to my heart’s content without having to move or interact closely with anyone, save my server.
And then on 23rd December, we are going to pretend that none of this is happening and allow people to mix in large numbers inside private houses again. It is people mixing in large numbers inside private houses that is spreading this virus, not small family units, like my own, enjoying a quiet meal at a local restaurant. “Epidemiological evidence?” I do not think they have the first notion of what it actually means. In the interests of balance, I should point out that Welsh First Minister, Mark Drakeford, has also jumped on the bandwagon and shut the pubs there again. It feels like those that govern us are waging war on the drinking classes.
The PM blunders and bumbles on. He is going to squeeze the disease and violate the virus and do something bad to the bug, he is going to pan the pandemic and turn up the testing and juice up the jabs. I am not even sure he is convincing himself, he is certainly not convincing many in his Party. It seems to me that there is always one Conservative faction that becomes the bane of their Leader’s life. Right now, it is the COVID Recovery Group, the CRG. If that sounds a lot like the European Research Group, the ERG, the nemesis of his predecessor, then it looks a lot like it too. A veritable rogue’s gallery of seasoned troublemakers and hooligans under a plausible sounding banner. The usual suspects you might say. It resulted in what, under other circumstances, I might have described as “wonderful” parliamentary pantomime on Tuesday, as the Government’s new measures were voted upon. Labour MPs abstained, allowing the CRG to rebel without the Government having to rely on Opposition support to get the rules through. Let us think about that for a moment. Labour MPs abstaining to allow the CRG to rebel without the Government having to rely on Opposition support to get the rules through, is exactly the Government having to rely on Opposition support to get the rules through. It is one of those things you cannot explain to your children. Boris tried to pacify the rebels by saying you could get out of more restrictive Tiers, and it might all come to an end on the 3rd February. 3rd February? Why? How? Epidemiological evidence I suppose.
It will certainly be too early for a vaccine to have made an impact, but is worth reflecting that our magnificent MHRA has acted with a speed and pragmatism that augers well for its future as a newly independent regulator from January. The pandemic, alongside alerting people to the benefits of sharing data for their own good, may also allow us to finally have a grown up, public conversation about the trade off between the risks and benefits of medical interventions. It is great that the vaccine is almost here, but now the difficult bit starts. It is right and proper that it will be NHS staff and the frail, elderly in our care homes first, but we know where they live. Finding everyone else for two shots, three weeks apart is not an insignificant challenge. We wish our own Minister in BEIS, Nadhim Zahawi, well as he takes on responsibility. Zahawi possess the skill, rare amongst his colleagues, of not getting flustered under intense interrogation. It is why you hear him a lot on the Today programme and see him a lot on Question Time. Take the time to witness him in action. He is a man that you might otherwise, easily underestimate.
And then there is Brexit. David Button was right to be optimistic last week about the prospects of a deal with the EU. I believe, as I always have, that there will at least be a deal of sorts in place before New Year’s Eve. My rather mischievous money is on an implementation period following the end of the transition period. There are two things, however, that are curbing my enthusiasm. First, the F word. Second, the fact that when I turned off the computer and cracked a can of cider last Wednesday night, plans were afoot in central government to celebrate the signing of a deal along with the business community. Afoot they remain.
In the meantime, as I think I may have mentioned once or twice before, the way you need to prepare for the year end is the same. There is more advice than you can shake the proverbial at on HMG web pages, and you can find the most relevant on our own site. But do sign up to the DHSC’s exchange site and the Trader Support Service for Northern Ireland. My main advice would be to make sure you have what you need for the UK in the UK, because even if Frosty and Barney come up with the goods, there will be different arrangements on either side of the border. That is likely to lead to delays, particularly on short straits crossings. The extent to which that may happen was laid bare last week with two days of horrible queues on the approach to Dover. The first five-miler was blamed on a French rehearsal of Brexit checks, whilst Friday’s jams were put down to a combination of “Christmas and Brexit stockpiling.” Christmas and Brexit stockpiling? You might have thought that could have been predicted. Someone (I cannot remember who, so answers on a postcard if you do), clever, witty and with obvious experience of commuting in and out of London’s Victoria station, once remarked that “Sundays, coming as they do with monotonous predictability, always seem to take British Rail Southern region by surprise.” It is how I tend to think of the way the NHS approaches Christmas. And August. In all seriousness, my sympathies are again with the people of Kent, especially those that live within a traffic delay of Dover. The implications of drivers being held up unexpectedly for hours on end, do lend themselves to a certain sort of humour, but the reality is rather quite unpleasant.
It might be easy, amongst all this, for us to forget that the NHS is on the verge of perhaps the most fundamental period of reform since its inception in 1948. Cue last week’s meeting of the NHS England Board. I would not normally be suggesting that you spent your spare time reading other people’s Board papers, but at the very least you need to get all you direct reports to read and give you a precis of this one. People’s eyes often glaze over at the mention of policy, but policy is just a way of organising things, getting them done. You have an expenses policy and a holiday policy in your organisations, health policy is simply about how the NHS will be run. I have always argued that everyone in our industry needs a solid grasp of health policy, it helps us better understand the environment in which we operate, and the better our understanding, the more successful we are likely to be.
Since 1990, I would argue, we have been in more or less continuous health reform, and it is possible to describe overriding themes that have defined periods of approximately a decade each. From 1990, it was about structure and function, creating the infrastructure for the internal market. From 2000, it was investment, the budget of the NHS doubled in actual terms during that period, and from 2010 we entered a time when the focus was on productivity. NHS historians will look back on the 2020s and see it as the decade of integration. Indeed, the paper I want you to read is entitled “Integrating Care - Next steps to building strong and effective integrated care systems (ICS) across England.”
If you have been paying attention, then there is not an awful lot that is new in here, it builds on 2019’s NHS Long Term Plan, and the two documents should be considered together. That said, Integrating Care, sets out some of the operational detail that the service needs as it prepares for England to be covered by ICS from April 2021. It confirms the direction of travel, but probably goes a little further in terms of place-based health and care, and differentiates place from the wider system in which it sits. The role of local authorities and, where they exist, metro Mayors is called out, and ICS will need to ensure local political buy-in as they prioritise service developments. Step one will be joining up the NHS pound, undoing internal market mechanisms and repealing elements of the 2012 NHS Act that hard-wired competition into the NHS. Step two will be moving health and social care closer together, we do have a Department of Health AND Social care after all. Step three will be integrating other public sector bodies whose work affects the wider determinants of health, ultimately delivering health and care in the same way as other public services.
This will take time, I think the full decade, and will, of course, continue to evolve. In the immediate term, Integrating Care sets out the legislative changes that the forthcoming NHS Bill should contain to enable the journey. Most were in Chapter 7 of the Long Term Plan, and at that time, then PM, Theresa May, indicated, perhaps surprisingly, an appetite to get the necessary on the books. Integrating Care, as well as providing the NHS with the information it needs, is also a timely nudge to a government who may already be a little bruised by legislative processes. The most significant piece of legislation is that which relates to the statutory status, or otherwise, of ICS. The document is billed a consultation, although I would personally stop short of that, given the only real question is “you do want ICS to have formal, statutory status don’t you?” Which is actually about right. We often talk about “the system” when “the system” does not exist, rather it is a reluctant amalgam of dozens of organisations, some of which have Foundation status, who just cannot get on with each other. “The system” needs to be “a thing.” I will have a closer look for you myself and get something out for those of you who enjoy a good old navel gaze.
Dates for your diary time now. On Monday 7th December, join us for a short webinar to find out how you can make the most of our virtual Parliamentary Reception, which is on Monday 18th January for those of you not already registered. And on Thursday 10th December, our friends at the OLS will be covering trader readiness in a bespoke webinar for ABHI members.
Elsewhere, Shaky has a new single record release, so I need you to go out and do whatever it is you need to do to return the great man to his rightful place at the top of the charts. It has been 35 years since his Xmas Number One. Its either the Welsh Elvis or the wonderful dancing binmen of Wolverhampton, who are raising money for a hospice that looked after both parents of one of our dearest friends.
And finally, I came across something on the wireless the other day which explains my drinking habits. And it is not because I grew up in the North West of England. It is the drunken monkey hypothesis, which, admittedly, does sound like a pub on the Golden Mile. It goes that we like alcohol because our primatial antecedents liked it, as they were attracted to fruits and nectar. Fruits and nectar on the forest floor ferment and produce alcohol which accumulates at low concentrations. It also wafts into the air, producing a vapor trail that reliably indicates the presence of a food source. Any animal that can sense and follow the smell will come to the source of the alcohol and, of course, the sugars within the fruit. In tropical forests, ripe fruit occurs patchily, so any ability to find it over long distances is beneficial. There you go, its genetic and not my fault, which must make it cider time. Cheers!