The Friday Blog: Bacon Diplomacy
The comedian, Al Murray, in his guise as the Pub Landlord, once postulated that the existence of bacon presented irrefutable evidence that there was a God and that he loved us. Rishi Sunak thinks the same. If you have already made the switch from Radio 4 / LBC to Heart / Smooth Xmas, you may have missed the fact that the PM was staring down the proverbial on Tuesday night. It was looking increasingly likely that he would lose a vote on the Second Reading of his Rwanda Bill, the main plank in his pledge to stop the boats. Even if it is unlawful and even if it was not, it would be finger in the dyke territory of actually making any sort of impact. Nobody loses a vote on Second Reading, especially not a Government with a working majority. It is the second least contentious part of passage of a Bill onto the statute books. The least contentious is when it is introduced to the House, then Second Reading is where the aims and general principles are outlined. Nothing to see here. Off it goes to Committee where it is scrutinised, line by line before being brought back and sent across to whichever House it did not originate in.
To put it into context, the last time a vote was lost at Second Reading by a viable government was in 1986. To make me feel really old, and illustrate just how much things have moved on, 1986 was the year in which I graduated (first time) and the piece of legislation in question was the Shops Bill, which was aiming to liberalise Sunday trading. Maybe God had a hand in that one too. In the end it did not cause undue grief for the incumbent at that time, who was, you know, wasshername, Snobby Roberts, the Plutonium Blonde, the Iron Lady, whatever you want to call her. Herself managed another four years in Downing Street. But I tell you this much, if Rishi is even in front line politics at Christmas 2027, things will have taken a very strange, interesting, and possibly even terrible turn.
Anyway, back to the bacon. As I reported last time, the plans have managed to upset people whose views on the subject are polarised. So, he has had them all around for breakfast, a fact attested to by any number of bleary-eyed Downing Street reporters, who were surprised that this was at actual breakfast time, not a Cameron like 9:30 for a couple of Hours before popping across the road to answer some bothersome questions on his way to the Carlton. It seems that, despite the early start, the winning move by Rishi was to provide bacon sandwiches to his potentially revolting MPs. Maintaining at least a modicum of control over his Party and not losing a vote which might have seen us hurtling towards a very early election, will have been pleasing for the PM who, only the previous day, had to negotiate a tricky five and a half hours at the COVID Inquiry. It started off in familiar vein, with questions about why Sunak had been unable to provide his WhatsApps from the pandemic. The PM said he has changed his phone multiple times, and that “as that happened the messages have not come across.” Which sounded like something like a previous PM might have said. In what might have been a canny political move, he neglected to stick the boot into the leadership of that particular PM.
But as the man said, we all knew just what he was here for. It was in his guise as “Dr. Death, The Chancellor,” and his “Eat Out to Spread it About” campaign. This is where being a diligent type comes in handy, and he was well prepared. He argued that, contrary to claims from Patrick Vallance and Chris Whitty, among others, there was plenty of time for officials to raise concerns if they had any, because the scheme was announced a month before it was implemented. Sunak pointed to several meetings after the plan was announced where it was not flagged as a potential issue. Asked why he himself did not seek advice before announcing the scheme, since both Vallance and Whitty have said they would have advised against it, he argued the “onus” was on officials to raise the issue if they felt so strongly about it. That is alright then. As cases ratcheted upward in September 2020, Sunak admitted he was “never particularly persuaded” by the concept of a circuit breaker lockdown, but lots of witnesses have said quicker action at the time, which never came, could have saved lives.
The consensus from the scribbling classes was that despite a few plays and misses, the cricket mad PM was solid enough on the front food and had reasonably successfully negotiated the worst the Inquiry could throw at him.
Be that as it may for his role in COVID, he is most certainly not out of the woods yet on Rwanda. Amendments will be coming thick and fast from both sides. The hang ‘em, flog ‘em and throw away the key brigade want things toughening up, whilst those who in another life might have joined the Labour Party or even the Lib Dems, are still to be convinced that even as is, the Bill does not breach international law. Next year, will be nothing if not interesting. The Bill goes wrong and we could be voting in the Spring, but if he steers it through then the Parliament will go deep, which I think will be his plan. It is what I would do and history suggests that if you think you might lose, you do not go early. Ask Gordon Brown.
Much against my better instincts I am going to take you to ICS land. A lot of people are, probably motivated by market access consultants somewhere or another, asking what are we doing with ICBs? Answer – come back in two years or if when they have sorted their governance out and got some levers. As once ICB CEO told us, “once you have seen one ICS, you have seen one ICS.” And there are 42 of the things at the moment. There will not be when it is all done and dusted, if that day ever comes, there will be 10, as I keep saying. Anyway, there is trouble.
In new recovery plans which they were required to publish by NHSE, multiple ICBs have said that stretched capacity means hardly any practices have signed up to the “general practice improvement programme”, which is meant to help them implement the national primary care access recovery plan. The ICBs pointed out that the programme is time-consuming, and practices which take part are not always given funding to pay for staff time. NHSE’s plan sought to improve ease and speed of access through spreading “modern” methods and processes; as well as measures to save clinicians’ time, improving same-day access, and delivering more appointments. To deliver the plan, NHSE said practices could take part in its “general practice improvement programme”, with a focus on moving to “modern” access tools, particularly digital phone systems, online messaging, and “modern” triage, designed to improve access and patients’ experience of contacting practices, which has been a huge focus of complaints and concerns in recent years. But the uptake of the improvement plan is off track, especially for “intermediate” and “intensive” support, which require substantial time for the practices, and are likely to be required by those most in need of help.
NHSE last week said 83 per cent of practices used digital telephony as of October, up from 70 per cent when the recovery plan was launched in May. The deadline for all practices is the end of March, ahead of all analogue systems being turned off by December 2025. Although national funding is available for the switch to cloud-based telephony, several ICB board reports said some practices were still choosing to remain on analogue systems.
In addition to staffing problems preventing practices joining the improvement programme, several ICBs said workforce shortages, particularly in fully qualified GPs, posed the biggest risk to primary care recovery.
While more than 31,000 other staff (such as pharmacists, physiotherapists and paramedics) have been hired since the launch of NHSE’s “additional roles reimbursement scheme” in 2019, fully qualified GP numbers have fallen from 27,489 in March 2019 to 26,718 in October this year. NHSE has said it wants to increase GP numbers by 6,000 by 2031-32, mostly by expanding GP training places.
Another focus of the primary care recovery plan was “cutting bureaucracy” for primary care, including by introducing more “self-referral routes”, where patients can access secondary without visiting a GP first. However, many ICBs board reports reveal they did not meet NHSE’s September deadline to establish self-referral in seven community-based services (falls, musculoskeletal, audiology for older people, weight management, community podiatry, and wheelchair and community equipment). An NHSE national progress report last week said ICBs had reported good progress and there were more than 600 services offering self-referral, although how many of these have been introduced since the plan in the spring recovery plan is not specified.
Meanwhile at Leicester, Leicestershire and Rutland Integrated Care Board it has been a case of Bah Humbug. Staff were offered an extra day holiday in December to go “festive shopping”, but the plan was then cancelled because of “escalating pressures”. In her first message to staff, CEO, Caroline Trevithick said the Board’s executive management team had “decided to share some seasonal spirit” and “thank colleagues with a day off work”. But then this from an ICB spokesperson: “Earlier in the week, given the escalating pressures and the announcement of the industrial action, ICB executives made the decision not to continue with the decision to offer any additional time off during December.”
The Grinches in this particular case appear to have been the medical staff. One senior clinician at UH Leicester said: “I’m changing my Christmas plans with my family so I can care for patients and respond to the news about yet more industrial action, and I’m dismayed that some people think it’s appropriate to give themselves an extra day of annual leave to go shopping.” I will not say anything about merit awards, private practice or anything else that is not available to long-suffering administrative staff.
Finally, back to where we started, and, as it happens, on one of the many occasions I have seen the Pub Landlord live, I made not one, but two schoolboy errors. Firstly, I believed the person in the Box Office that Row AA was not, in fact, the second one back from the stage. Secondly, I wore a pink shirt. If you have ever been, you know how this story ends. About every 10 mins being required to stand up and sing the National Anthem. With that, greetings of the season to you and yours and the Blog will return mid January.
