The Friday Blog: Take the Credit
A good Friday afternoon once again everyone. As you can see, I have decided to return from my summer holidays, and not just because I do not want you getting the idea that there is a surfeit of people out there who can fill this column week in week out. I am, however, very grateful to our great friends Melissa Barnett and Dan Jones from PB Political Consulting, who have, I hope, kept you entertained and informed in equal measure these past couple of weeks. Now, there is, of course, the mortgage on a tumbledown cottage and new school uniforms for the girl. I had anticipated blazers, blouses, skirts and trousers, but she needs Aprons as well. Aprons! Two of them. And the list of essential sporting equipment is as long as that of a professional first-class cricketer. Still, she looks good in it all and is looking forward to 4th September, when the new intake gets the school to itself for the day, with at least a modicum of anticipation and excitement.
I do hope this finds you all safe and well and you have enjoyed, or about to enjoy at least, some sort of summer break. My thoughts and texted wishes have been with friends and colleagues who have based their plans around visits to France and Spain. Mine was very pleasant, thanks for asking. It was also much needed on the mental health front, as you will have picked up from my ramblings here in recent months. As well as the dad and daughter break I told you about, we had a last minute family visit to our bolthole in the Cotswolds, the wonderful Bear, sitting high above Stroud on Rodborough Common. This is Laurie Lee country, the Gloucester Cotswolds, not the Oxford ones, and there is a different feel. It is a bit like moving from Devon to Cornwall. The neighbouring counties are, quite literally, inextricably linked and share a common landscape, but one is perhaps prettier, gentler, the other more rugged and dramatic. I did put a fair few miles on the new hiking boots, but I am not sure that activities based around bars and restaurants would have done much to stave off whatever it is I am likely to succumb to. But what was I supposed to do? I spent three days last week resident in a Lancashire Pub, with real Lancashire Bitter beer and a menu that included lamb hot pot, a “Worston plate meat pie,” and jam roly poly and syrup sponge for afters. Fill yer boots? Of course I did.
I even had a disconcerting memory moment. Sat in the garden the other weekend, I had Radio 4 Extra’s Comedy Club on. Arthur Smith was interviewing someone, not known to me, but with an obvious musical element to her act. For reasons that were not readily apparent, Smith decided that the item should end with a Hymn and chose “Now Thank We All Our God.” This was my old school Anthem, and I was a bit worried that my recollection of the words was somewhat imprecise. In my defence, it was not as if we sang it every day, which set me off on my next memory test of when we did actually perform it studiosum corpus. First day of the school year, probably the last, Speech Day certainly, and various other ad hoc ceremonials. So, it is possible I have only ever sung / mumbled / stood and listened to the thing no more than 30 times in my life, and it is nearly 40 years since I last donned the green blazer. I consoled myself with the fact that there are, without exaggeration, probably a 1,000 tunes that if they came on the radio now, I would be word perfect on the in-car karaoke, including the entire back catalogues of Shakin’ Stevens, Eddie Cochran, Tom Jones and Del Amitri. I will just keep taking the medicine I suppose.
I did a pretty good job at avoiding the news media whilst I was off, although a couple of things did catch my eye. It seems that, as measured by number of deaths, we have done better than we thought on managing COVID. We have just been counting it wrong. Now, that sounds like a champion wheeze to me. If you are doing poorly on your performance metrics, just change the way you measure them. I bet all you sales managers reading this are hoping that your Reps do not catch on. It reminds me of a sales incentive scheme I was once subjected to in my drug selling days, grandly titled “Take the Credit.” The idea was sound enough, but it quickly became known as “Take Someone Else’s Credit” or “Take the Proverbial” depending on how angry you were. We were one of the biggest companies in the world at the time with a UK Sales Force to match. Each team was ranked, and everyone was sent a pre-paid credit card. Get it? Out came the results, but there was a hitch. Those in charge had been counting it wrong, so the next day an entirely different league table appeared. I did all right. My wife at the time was also a rep but in another team. One day I was a leading performer and she was nowhere to be seen, the next I was mid table mediocrity and she was top of the pile. Our household had a net gain, but there were any number of disgruntled people who had already spent the cash they now no longer had. I must admit, though, I do not envy those of you who have to set sales incentives at the moments, what with buying patterns all over the place for the foreseeable and some of your capital sales guys having delivered ordinarily career long targets in the last quarter. My advice is not to over think it. You will get it wrong. You always do. And the Reps will find a way of maximising their payback without delivering quite what you anticipated. They always do. It is a consequence of the skills you hired them for.
There is a serious point of course. There have been significant discrepancies between the numbers being produced by Public Health England, NHS England and the Office of National Statistics. In some ways it is not surprising. Ask three people to measure the same thing without giving them a common methodology, and you will get three different answers. If we are serious about the integration of care, and public health is part of that, then local systems need data they can believe in and own. Information devised by national organisations to serve their own needs is not going to cut it. It looks like the victims of this will be Public Health England, actually the only Executive Agency (government) of the three. I listened to Matt Hancock on the radio trying to explain how the creation of a new National Institute for Health Protection would help focus efforts on the COVID response by combining a number of hitherto independent programmes. I am not sure he even convinced himself. It seems to me that the new Institute will focus on this, and future pandemics, which leaves a lot of public health left to be done, not least the prevention agenda and sexual health and other services that moved from the NHS to Local Authority bailiwicks following the 2012 Health and Social Care Act. Now is the time to join them up.
And if you doubted that was the intention, revisit Andrew Davies’ excellent blog on the “Phase Three recovery” letter from Simon Stevens. Andrew, quite rightly, focussed on the implications for the restart of elective activity and the ongoing financial arrangements for funding providers whose plans were based on what are now, temporarily or permanently, redundant currencies. But there was an awful lot in the letter that caught my eye from a policy perspective. Indeed, there has been some speculation on health-related social media that Stevens is attempting to force the move to Integrated Care Systems (ICS) under the radar.
Stevens took the opportunity to stress that working across systems, including the NHS, local authorities and the voluntary sector, has been essential for dealing with the pandemic and the same is true in recovery. But he went further, stressing that as we move towards comprehensive ICS coverage by April 2021, all ICSs and STPs should embed and accelerate this joint working through a development plan, agreed with their NHSE/I regional director. Plans should include collaborative leadership arrangements, agreed by all partners, that support joint working. This also means appointing a single STP/ICS leader and a Non-Executive chair, and clearly defined arrangements for provider collaboration, place leadership and integrated care partnerships. Organisations within the system will come together to serve communities through a Partnership Board, underpinned by agreed governance and decision-making arrangements including high standards of transparency, in which providers and commissioners can agree actions in the best interests of their populations, based on co-production, engagement and evidence. There will be a streamlined commissioning through a single ICS/STP approach, typically leading to a single CCG across the system. There should be a plan for developing and implementing a full shared care record, allowing the safe flow of patient data between care settings, and the aggregation of data for population health. It all sounds rather prosaic, but these are the essential building blocks for a new way of delivering health and care in our country, and if there has been some opportunism from the Chief Executive of NHS England ahead of the necessary legislation, it might not necessarily be a bad thing.
As the Non-Executive Board lead responsible for Equality and Diversity at an NHS Hospital, I was also taken by moves to strengthen leadership and accountability, a named executive Board member responsible for tackling inequalities must be in place by September in every NHS organisation. Each NHS Board must also publish an action plan showing how over the next five years its Board and senior staffing will, in percentage terms at least, match the overall BAME composition of its overall workforce, or its local community, whichever is the higher. It was, in many ways, a remarkable letter, and how it might influence what happens in the anticipated power grab by central government in the coming months will be one to follow.
It has been all go, or otherwise on the trade front. It seems that there is now no prospect of a deal with the US being secured before November’s Presidential election, and you do wonder to what extent that is influenced by the polling numbers stateside. And I could not miss the story last week that the talks with Japan supposedly got side-lined by Trade Secretary Liz Truss looking to get a quick win on blue cheese. The official line remains that there will be an outline deal in place by the end of this month, although that might be driven by the Japanese desire to get something to replace the EU deal before the end of the Transition Period, as much as anything else.
Noting these setbacks, if indeed that is what they are, as well as comments from New Zealand’s deputy PM that U.K. trade negotiators are not “match fit,” those from the EU are smelling blood. “The U.K. desperately needs this deal,” an EU official closely involved in the talks said. “If the clock is ticking, reality will start to sink in in London… Surely the pandemic and the lack of trade alternatives must lead to some reason in London?” A U.K. official pushed back that it’s “a bit of a stretch” to think London will be rushing to do a deal with the EU simply because its other trade negotiations are not working out yet.
We will know soon enough, they have been back at it this week. David Frost headed to Brussels on Tuesday evening for dinner with Michel Barnier, talks on Wednesday and Thursday and breakfast this morning to wrap up. The sticking points are what they always have been, level playing fields, notably on state aid, the role of the European Courts of Justice in dispute resolution and fish. Ever the fish. And it looks like the fish are slippery. After another few days in which little progress was made, Frost said the UK was seeking a deal which "ensures we regain sovereign control of our own laws, borders, and, (listen up), waters". When the EU accepts this reality in all areas of the negotiation, it will be much easier to make progress.” Barnier admitted there had been “no progress whatsoever” on the fish, and went on to say that he was "disappointed" and "concerned". Frost spoke of "little progress", amid differences on fisheries policy and state aid rules. The latter, one of the level playing field demands from Europe, is a non-negotiable if the UK wants access to the EU market. As Barnier said, "We are asking for nothing more but nothing less, nothing less than what Prime Minister Boris Johnson committed to in our joint political declaration last October together with the 27 EU leaders.”
The next round of talks is due to begin on 7 September in London, but it is looking increasingly tricky. Barnier does not operate vacuum, and France is apparently jumpy that he may be so keen to be seen to get a deal done this autumn that he could be tempted to give away too much whilst German Chancellor Angela Merkel is adamant that the EU will not agree to anything it believes would damage its single market. Here, our PM, who appears to have all but disappeared, desperately needs something to repair his increasingly damaged credentials. October, by when perceived wisdom dictates a deal needs to be done, looms very, very large.
Whilst talks continue, or otherwise there is plenty happening with the contingency planning the rest of us have to do regardless. The DHSC will be a running a trader readiness webinar at 2pm on Thursday 27 August (register here), and further guidance on arrangements for the Irish border has been issued, so do stay tuned in to our Brexit resources page where you will find the latest information all in one place. I am thinking we have about a week left of relative calm, so make the most of it. I am off (back) to the pub.
