Life begins at forty: how grand plans mislead
by Rory Coonan

In politics everything must be ‘transformed’ because no-one votes for modest improvements. But what if promises turn out to be fantasies? And what do they say about the truth and integrity of those who make exaggerated promises?

Two announcements prompt this question. The first is the government’s election pledge to build 40 new hospitals. The second is the government’s promise to create some 40 new integrated care partnerships. Both merit scrutiny.

New Hospitals

The promise to build “40 new hospitals” was made in the Conservative party’s 2019 general election manifesto. The present author once helped to oversee the design and construction of a new hospital.  A new hospital is first and foremost a new building on a new site. Second a new hospital offers new treatments underpinned by new systems and resources, adding new capacity to local health services.  The public would recognise these combined elements as “a new hospital”. Isn’t it a fundamental test of novelty that the new thing does not exist already?

Applying this definition to the government’s pledge it turns out that the future “new hospitals” are an unrealisable invention.  According to analysis by the Nuffield Trust, over half (22) are rebuilding projects within existing hospitals. 12 are building extensions such as a new wing or additional operating theatres while 3 are replacements for existing hospitals. Only 2 are brand new hospitals.

What of the 2 that are brand new? Both predate the ’40 new hospitals’ pledge yet are included in it. The Midland Metropolitan University hospital in the West Midlands should have opened in 2018. It was conceived decades ago. The National Audit Office says costs have risen from £350 million to a £1 billion (the construction firm collapsed). The new hospital may open next year but it may not. Meanwhile, the £375 million Royal Liverpool hospital was due to begin in 2013. It is still incomplete (the construction firm collapsed) and costs have risen to over £1 billion.

By no stretch of the imagination does the plan amount to “40 new hospitals”. The suit I bought a decade ago cannot be counted as a new suit this year simply because I say it is, any more than patching a hole in my jacket means I have a new jacket.

Key Media Lines

The department of health and social care issued guidance to NHS hospital trusts about the programme in August 2021.  The guidance is an instruction called “key media lines”. Viewing the world through the distorting prism of ‘the media’ it said plans for hospital refurbishment schemes, new wings, alterations and other capital improvement projects “must always be referred to as a new hospital”.

This phrase is worthy of George Orwell’s ‘Newspeak’ in his novel Nineteen Eighty-Four (“…the whole aim of Newspeak is to narrow the range of thought. In the end we shall make thoughtcrime literally impossible”). A thought crime was narrowly avoided by badging the Northern centre for cancer care (opened 2021) as a new hospital even though it remains stubbornly a wing of the Cumberland infirmary.

The National Audit Office, the government’s independent spending ‘watchdog’, has announced a “value for money review” of the government’s hospital claims. It will report its finding in 2023.  Some would say it need not take so long. It appears the government has been rumbled. If only it had promised what it is delivering, to its credit, namely an affordable programme of useful hospital refurbishments, valuable extensions, additional capacity and genuine improvements – in other words, the truth.

Integrated Care Partnerships.

The second announcement is equally deserving of scrutiny. Established by law, some 40 new “integrated care partnerships” will bring together family doctors, local authorities and hospitals. Together, they will plan and deliver health and care services locally. (Greater Manchester health and social care partnership already exists and has apparently tested the new approach).

Everyone agrees that ‘social care’ (or care at home including personal care) is a major cause of blockages in general hospitals and that ‘health’ and ‘care’ have existed too long in separate compartments. But as with the government’s claims for new hospitals, the plan is spoiled because it is accompanied by excessive hyperbole and unsubstantiated promises.

Clubs and betting shops – the new health inspectors

The chief executive of the NHS, Amanda Pritchard, said the new partnerships “would completely transform health and care for people in their local communities…..with the power to truly transform the way that we care for people up and down the country. [my italics].

She said this work has already begun, and (to some people) in improbable locations: “Local areas are already doing this by going out into communities to spot signs and symptoms earlier in places such as sports clubs and betting shops.”  She went on to claim that the changes “would save taxpayers millions of pounds each year”.

Leaving aside the comic prospect of NHS officials touting for health in the local bookies, there is no settled measurement by which the new policy will be judged transformative of public health and care (this would take many, many decades to assess). Nor is there a shred of evidence that it will save a penny. The practical change envisaged by the new integrated care partnerships is new joint committees. Their meetings will take minutes and spread over years.  Otherwise, the participating bodies will continue as always with their fixed costs and employees. And surely it is axiomatic that health and social care costs rise? They never fall. If they do their jobs, the new partnerships will stimulate demand. This entails the opposite of saving money.

Whether it be treating exaggerated claims for new hospitals or casting a critical eye on other improbable transformations, we could do worse than recall Alice’s observation, in Alice in Wonderland, that sometimes she could believe in ‘six impossible things before breakfast’. We are surely right to be truly, madly and deeply sceptical when we’re asked to believe in 40.

Life begins at forty: how grand plans mislead
by Rory Coonan

In politics everything must be ‘transformed’ because no-one votes for modest improvements. But what if promises turn out to be fantasies? And what do they say about the truth and integrity of those who make exaggerated promises?

Two announcements prompt this question. The first is the government’s election pledge to build 40 new hospitals. The second is the government’s promise to create some 40 new integrated care partnerships. Both merit scrutiny.

New Hospitals

The promise to build “40 new hospitals” was made in the Conservative party’s 2019 general election manifesto. The present author once helped to oversee the design and construction of a new hospital.  A new hospital is first and foremost a new building on a new site. Second a new hospital offers new treatments underpinned by new systems and resources, adding new capacity to local health services.  The public would recognise these combined elements as “a new hospital”. Isn’t it a fundamental test of novelty that the new thing does not exist already?

Applying this definition to the government’s pledge it turns out that the future “new hospitals” are an unrealisable invention.  According to analysis by the Nuffield Trust, over half (22) are rebuilding projects within existing hospitals. 12 are building extensions such as a new wing or additional operating theatres while 3 are replacements for existing hospitals. Only 2 are brand new hospitals.

What of the 2 that are brand new? Both predate the ’40 new hospitals’ pledge yet are included in it. The Midland Metropolitan University hospital in the West Midlands should have opened in 2018. It was conceived decades ago. The National Audit Office says costs have risen from £350 million to a £1 billion (the construction firm collapsed). The new hospital may open next year but it may not. Meanwhile, the £375 million Royal Liverpool hospital was due to begin in 2013. It is still incomplete (the construction firm collapsed) and costs have risen to over £1 billion.

By no stretch of the imagination does the plan amount to “40 new hospitals”. The suit I bought a decade ago cannot be counted as a new suit this year simply because I say it is, any more than patching a hole in my jacket means I have a new jacket.

Key Media Lines

The department of health and social care issued guidance to NHS hospital trusts about the programme in August 2021.  The guidance is an instruction called “key media lines”. Viewing the world through the distorting prism of ‘the media’ it said plans for hospital refurbishment schemes, new wings, alterations and other capital improvement projects “must always be referred to as a new hospital”.

This phrase is worthy of George Orwell’s ‘Newspeak’ in his novel Nineteen Eighty-Four (“…the whole aim of Newspeak is to narrow the range of thought. In the end we shall make thoughtcrime literally impossible”). A thought crime was narrowly avoided by badging the Northern centre for cancer care (opened 2021) as a new hospital even though it remains stubbornly a wing of the Cumberland infirmary.

The National Audit Office, the government’s independent spending ‘watchdog’, has announced a “value for money review” of the government’s hospital claims. It will report its finding in 2023.  Some would say it need not take so long. It appears the government has been rumbled. If only it had promised what it is delivering, to its credit, namely an affordable programme of useful hospital refurbishments, valuable extensions, additional capacity and genuine improvements – in other words, the truth.

Integrated Care Partnerships.

The second announcement is equally deserving of scrutiny. Established by law, some 40 new “integrated care partnerships” will bring together family doctors, local authorities and hospitals. Together, they will plan and deliver health and care services locally. (Greater Manchester health and social care partnership already exists and has apparently tested the new approach).

Everyone agrees that ‘social care’ (or care at home including personal care) is a major cause of blockages in general hospitals and that ‘health’ and ‘care’ have existed too long in separate compartments. But as with the government’s claims for new hospitals, the plan is spoiled because it is accompanied by excessive hyperbole and unsubstantiated promises.

Clubs and betting shops – the new health inspectors

The chief executive of the NHS, Amanda Pritchard, said the new partnerships “would completely transform health and care for people in their local communities…..with the power to truly transform the way that we care for people up and down the country. [my italics].

She said this work has already begun, and (to some people) in improbable locations: “Local areas are already doing this by going out into communities to spot signs and symptoms earlier in places such as sports clubs and betting shops.”  She went on to claim that the changes “would save taxpayers millions of pounds each year”.

Leaving aside the comic prospect of NHS officials touting for health in the local bookies, there is no settled measurement by which the new policy will be judged transformative of public health and care (this would take many, many decades to assess). Nor is there a shred of evidence that it will save a penny. The practical change envisaged by the new integrated care partnerships is new joint committees. Their meetings will take minutes and spread over years.  Otherwise, the participating bodies will continue as always with their fixed costs and employees. And surely it is axiomatic that health and social care costs rise? They never fall. If they do their jobs, the new partnerships will stimulate demand. This entails the opposite of saving money.

Whether it be treating exaggerated claims for new hospitals or casting a critical eye on other improbable transformations, we could do worse than recall Alice’s observation, in Alice in Wonderland, that sometimes she could believe in ‘six impossible things before breakfast’. We are surely right to be truly, madly and deeply sceptical when we’re asked to believe in 40.

Life begins at forty: how grand plans mislead
by Rory Coonan

In politics everything must be ‘transformed’ because no-one votes for modest improvements. But what if promises turn out to be fantasies? And what do they say about the truth and integrity of those who make exaggerated promises?

Two announcements prompt this question. The first is the government’s election pledge to build 40 new hospitals. The second is the government’s promise to create some 40 new integrated care partnerships. Both merit scrutiny.

New Hospitals

The promise to build “40 new hospitals” was made in the Conservative party’s 2019 general election manifesto. The present author once helped to oversee the design and construction of a new hospital.  A new hospital is first and foremost a new building on a new site. Second a new hospital offers new treatments underpinned by new systems and resources, adding new capacity to local health services.  The public would recognise these combined elements as “a new hospital”. Isn’t it a fundamental test of novelty that the new thing does not exist already?

Applying this definition to the government’s pledge it turns out that the future “new hospitals” are an unrealisable invention.  According to analysis by the Nuffield Trust, over half (22) are rebuilding projects within existing hospitals. 12 are building extensions such as a new wing or additional operating theatres while 3 are replacements for existing hospitals. Only 2 are brand new hospitals.

What of the 2 that are brand new? Both predate the ’40 new hospitals’ pledge yet are included in it. The Midland Metropolitan University hospital in the West Midlands should have opened in 2018. It was conceived decades ago. The National Audit Office says costs have risen from £350 million to a £1 billion (the construction firm collapsed). The new hospital may open next year but it may not. Meanwhile, the £375 million Royal Liverpool hospital was due to begin in 2013. It is still incomplete (the construction firm collapsed) and costs have risen to over £1 billion.

By no stretch of the imagination does the plan amount to “40 new hospitals”. The suit I bought a decade ago cannot be counted as a new suit this year simply because I say it is, any more than patching a hole in my jacket means I have a new jacket.

Key Media Lines

The department of health and social care issued guidance to NHS hospital trusts about the programme in August 2021.  The guidance is an instruction called “key media lines”. Viewing the world through the distorting prism of ‘the media’ it said plans for hospital refurbishment schemes, new wings, alterations and other capital improvement projects “must always be referred to as a new hospital”.

This phrase is worthy of George Orwell’s ‘Newspeak’ in his novel Nineteen Eighty-Four (“…the whole aim of Newspeak is to narrow the range of thought. In the end we shall make thoughtcrime literally impossible”). A thought crime was narrowly avoided by badging the Northern centre for cancer care (opened 2021) as a new hospital even though it remains stubbornly a wing of the Cumberland infirmary.

The National Audit Office, the government’s independent spending ‘watchdog’, has announced a “value for money review” of the government’s hospital claims. It will report its finding in 2023.  Some would say it need not take so long. It appears the government has been rumbled. If only it had promised what it is delivering, to its credit, namely an affordable programme of useful hospital refurbishments, valuable extensions, additional capacity and genuine improvements – in other words, the truth.

Integrated Care Partnerships.

The second announcement is equally deserving of scrutiny. Established by law, some 40 new “integrated care partnerships” will bring together family doctors, local authorities and hospitals. Together, they will plan and deliver health and care services locally. (Greater Manchester health and social care partnership already exists and has apparently tested the new approach).

Everyone agrees that ‘social care’ (or care at home including personal care) is a major cause of blockages in general hospitals and that ‘health’ and ‘care’ have existed too long in separate compartments. But as with the government’s claims for new hospitals, the plan is spoiled because it is accompanied by excessive hyperbole and unsubstantiated promises.

Clubs and betting shops – the new health inspectors

The chief executive of the NHS, Amanda Pritchard, said the new partnerships “would completely transform health and care for people in their local communities…..with the power to truly transform the way that we care for people up and down the country. [my italics].

She said this work has already begun, and (to some people) in improbable locations: “Local areas are already doing this by going out into communities to spot signs and symptoms earlier in places such as sports clubs and betting shops.”  She went on to claim that the changes “would save taxpayers millions of pounds each year”.

Leaving aside the comic prospect of NHS officials touting for health in the local bookies, there is no settled measurement by which the new policy will be judged transformative of public health and care (this would take many, many decades to assess). Nor is there a shred of evidence that it will save a penny. The practical change envisaged by the new integrated care partnerships is new joint committees. Their meetings will take minutes and spread over years.  Otherwise, the participating bodies will continue as always with their fixed costs and employees. And surely it is axiomatic that health and social care costs rise? They never fall. If they do their jobs, the new partnerships will stimulate demand. This entails the opposite of saving money.

Whether it be treating exaggerated claims for new hospitals or casting a critical eye on other improbable transformations, we could do worse than recall Alice’s observation, in Alice in Wonderland, that sometimes she could believe in ‘six impossible things before breakfast’. We are surely right to be truly, madly and deeply sceptical when we’re asked to believe in 40.