The Friday Blog: Fare thee well
A very good Friday afternoon to one and all. How are you parenting types getting on? Is anyone, honestly now, thinking anything other that “one down, five to go?” I am contemplating enforcing the Government’s new regulations on face coverings indoors, not least as a peace keeping measure. Not that I have much of a say on what happens indoors, but rattling my little toy sabre every now and then makes me feel a bit better about the world. My confidence in anything coming out of Her Majesty’s Government may be somewhere between low and zero, but I have absolute blind faith in the fact that the schools will reopen in September.
There has been a lot going on this week that I could pick up here, it has been absolute manna for the sketch writers after exceptionally long periods of sameness. Top of the list has to be that it seems Dominic Cummings was not the evil mastermind behind Brexit after all. It was the Russians. It is like being back in the Cold War. Blame the Russians. They have been busy those Russians too, getting the UK out of the EU and getting Trump into the White House. If it was a government-backed conspiracy to prevent a potentially damaging report from the Commons Intelligence and Security Committee appearing before the last general election, I am not sure why. I think many voters looking at Jeremy Corbyn were worried about a different type of Russian influence on British public life had he entered Downing Street. I do not imagine that HMG will be too worried about its contents, it seems to me that this sort of thing is de rigueur in certain circles. It is what we have a security service for is it not? I remember a former CIA operative being interviewed after rumours that the SVR had influenced the 2016 US General Election. His only surprise was that people were surprised, offering a metaphorical shrug when asked if it might have happened. “Do you think that western democracies have interfered in a similar way,” he was asked. Our spook was incredulous, “Of course they have,” he replied, “every country intervenes in the domestic business of another if it has an interest in doing so.”
But I am not going to touch that, or the break up of the Union, with the difference being that this time it is the Scots that will be building the wall, or anti-Semitism in the Labour Party or face coverings in public. I suppose I ought to mention Brexit negotiations which were back on this week. At the end of five weeks of what were described as “tunnel negotiations,” it is still not looking good, if you believe the press that is.
After things had wrapped up yesterday, EU chief negotiator Michel Barnier said a deal looked "at this point unlikely" given the UK position on fishing rights and post-Brexit competition rules. Once again, his UK counterpart David Frost was more upbeat, acknowledging that "considerable gaps" remained in these areas, but a deal was still possible.
This was the second official negotiation round to be held in person since the coronavirus crisis, after both sides agreed to "intensify" talks in June. The chief negotiators are due to meet informally in London next week, with another round of official talks scheduled for mid-August in Brussels.
Speaking after the talks, Mr Barnier said the UK had not shown a "willingness to break the deadlock" over fisheries and post-Brexit rules on competition.
"By its current refusal to commit to conditions of open and fair competition and to a balanced agreement on fisheries, the UK makes a trade agreement at this point unlikely," he told reporters.
He said there was a risk of no deal being reached unless the UK changed course on the topics, which were "at the heart" of the EU's trade interests. Frost said fisheries and the rules on competition, known as "level playing field" provisions, remained the "most difficult areas,” but still believes a deal could be reached in September, but the government must "face the possibility" one will not be struck.
But he added the EU had shown a "pragmatic approach" over British demands to limit the role of the European Court of Justice after the transition period ends. Frost also said that the UK, which has so far insisted on a series of separate deals in different areas, was also willing to consider a "simpler" structure for an agreement. But it is not going to happen by the end of July as the PM had promised. Déjà vu anyone? There might yet be some cause for optimism. Paul McGrade, Lexington Communications’ Trade Counsel was upbeat at ABHI’s “Brexit; The Final Chapter?” yesterday. The former Foreign Office man warned delegates not to believe negative press speculation and had confidence that the PM, once it is all said and done, will have upheld his reputation as a deal maker.
Beyond all this, there has been cause for some policy wonking these past couple of weeks. It is what I thought I had joined ABHI for in the first place, but no sooner had I arrived then my world became one of continuity trade agreements, rules of origin and border delivery. Not to mention recent events which have necessitated epidemiology and troubleshooting. Still, if there is one place in this world where it is legitimate to, at least try to be all things to all people, it is in a trade body. Bubbling under, as they say, is the governance of the NHS. There has been disquiet in Whitehall about its ability to really pull the strings since 2012. I do not think we need to use this forum to dissect the dog’s dinner that was the Health and Social Care Act, suffice to say it bore the scars of being a product of the 2010 coalition agreement. Any vision that Andrew Lansley had for the future of the NHS was compromised out of existence. The abolition of Primary Care Trusts was not consistent with the intent of the Act and was, in fact, a Lib Dem manifesto commitment. Other elements that hardwired competition in the service, at a time when collaboration had been recognised as the best way to drive the efficiencies so badly needed, will now need to be undone. More of that later.
What really miffed Ministers was placing the NHS at arm’s length from the Department. Lansley’s preamble proudly proclaimed that Richmond House would no longer be the headquarters of the NHS and he would not meddle in the day-to-day running of the service. The Act created the NHS Commissioning Board, which still actually exists, we just call it NHS England. The Board received its cash from the Department and was left to get on with it. Except that it had to deliver the objectives of a National Outcomes Framework, which was drawn up by the Secretary of State and the Chief Executive of the NHS was also answerable to the Secretary of State. The cynic in me says that is an age-old government tactic of trying to retain control whilst passing accountability to others. It never works. Government still has to deal with the difficult questions. The Blair administration learnt that when it invented the National Institute for Clinical Excellence in 1999. The first decision NICE made was to say no to Relenza, Glaxo’s great hope. It was left to Downing Street to pacify the Pharma sector, whose business model of finding put it in the water molecules to treat chronic, relapsing conditions, was changing.
So, if you are going to cop the stick anyway, you just as well do it yourself. That, apparently, is what young Matt Hancock was keen to do. Frustrated that he was not able to precisely orchestrate the NHS during the pandemic, now was the time, he thought, to take back control. To coin a phrase. He had his Department running around drafting a Bill and was aiming to force it through Parliament in short order. Pre this week’s Recess short order.
But, Downing Street got the willies and the PM’s advisers decided against taking the risk of trying to pass controversial legislation whilst winter pressures and possible resurgent waves of COVID battered the NHS. Legislation, however, is on the way at some point, not least because it is needed to allow the NHS to deliver its Long Term Plan. Chapter Seven of the Plan set out possible legislative changes, including removing competition and procurement rules, allowing NHS England and NHS Improvement to merge and enabling providers and commissioners to work closely together through joint committees. Theresa May’s government, to my surprise given its bonfire of regulations approach, warmed to the idea and the Conservative Party committed to enacting the proposed legislation in its 2019 manifesto. But I expect what we see will go further, making Integrated Care Systems statutory organisations for example. That seems to me to be the only way of making them work. We talk about “the system” at various levels, but there is no system, rather a whole lot of free-standing organisations with a duty to look after only themselves. It is something that HM Treasury will also applaud, preferring to know exactly where the money is. A busy Autumn for us at ABHI Towers on the legislative front ahead, especially with the news that the Second Reading of the Medicines and Medical Devices Bill in the Lords’ has been postponed from next week until September.
It has been a tricky week this one, and not just because it is one down, five to go. I do not recall one where we have had quite so many moving parts to operate. I console myself, then, that I am not the PM, who is taking himself off to Scotland today to mark the first anniversary of his leadership of the Tory Party. I think it is fair to say that he is not universally popular north of the border. His polling numbers there are horrible and exactly what Scottish Tories had feared from a Johnson-led government, and indeed why they formed a memorable campaign dubbed “Operation Arse” to try to keep him out of power. Speaking on BBC Newsnight last night, Scottish historian Professor Tom Devine spelled out the problem in simple terms. “This is the first time since the demise of Margaret Thatcher that there’s been another U.K. Prime Minister who is almost as equally disliked in Scotland,” he said. “The difference is, there is a degree of contempt for Johnson in a way there wasn’t for Thatcher…There was a degree of respect for Thatcher.” Fare thee well, Prime Minister, fare thee well.
