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Andy Cowper Profile picture
Andy Cowper
@HPIAndyCowper
Editor, Health Policy Insight/Cowper’s Cut. “Invaluable, insightful, funny: excellent value for money. Subscribe!" @NicholasTimmins @hpiandycowper.bsky.social
Apr 2 • 12 tweets • 3 min read
Abolishing NHS England.

Mmmmmm.

Tempting as hell, given its performance over recent years - and a leadership that is, in one of my favourite Lancashireisms, “neither use nor ornament”.

But sometimes you have to stop and properly think about things. This is one of those times. Primary legislation takes political time and effort, and is needed if you want to abolish NHS England.

So if you want to change NHS England for the better, then you ought to pay attention to the work of a subtle subversive.
Mar 3 • 13 tweets • 3 min read
“We need to restart the programme of public sector reform from before the pandemic”, Chancellor @Jeremy_Hunt tells the Kuenssberg Show. He intimates that cutting bureaucracy can free up lots of clinicians’ time.

Ahem. Bit of a history lesson needed. The Lansley reforms cut the management resource in the NHS in England by 45%. theguardian.com/politics/2010/…
Feb 12 • 21 tweets • 3 min read
Oooops. The Prime Minister has inadvertently told a massive bunch of lies about the NHS.
Oct 28, 2022 • 4 tweets • 1 min read
“Effective collaboration is not about doing more, but about doing less more quickly. Staff who say ‘it’s not my problem’ see immediate gains in productivity. The Japanese call this Nokandu, after the ancient art of passing the parcel.” The magnificent @jtweeterson hsj.co.uk/policy-and-reg…
Oct 27, 2022 • 5 tweets • 1 min read
EveryGrifter are re-branding, I see. Honestly couldn't say which group of people I detest more: EveryGrifter; or the people who are idiot enough to give them money.
Nov 21, 2021 • 24 tweets • 5 min read
There is A Big Old Lot Of Bollocks being talked about the Health Bill going back to the Commons tomorrow. Preventing the talking of such bollocks is a bit of a Sissyphean task, but here goes with a shot at it.
Jan 7, 2021 • 25 tweets • 3 min read
Well. This is a thing from Alan. “The case for the defence of the Health Department during 2020 is that we backed a lot of horses,. The majority of them came home. Some of them had hiccups along the way.
Jan 7, 2021 • 5 tweets • 2 min read
Isabel is once again, spot-on. What also emerged today (via @DavidProviders) is that the NHS capital/maintenance/estates backlog has risen over the past year from £6.5bn to £9bn. If you put an approximate cost of £12bn (by the time there is capacity to get round to addressing the estates/maintenance work), and WLI of around £12-15bn (based on this health.org.uk/publications/l… plus the additional Covid backlog), then there’s some bracing NHS spending to be done
Jan 6, 2021 • 4 tweets • 1 min read
The vaccination programme is a great unifier. It unites the worst and most stupid MPs in the Labour Party theguardian.com/politics/2021/…
Jan 6, 2021 • 6 tweets • 2 min read
"As Matt Hancock told us this week, thanks to the wonders of science, 1.3 million people in the UK have now been vaccinated. Science is a field of endeavour previously closed to Britain by the EU, as he has pointed out many times. "This is almost the same number of people who currently have the virus, which means we’ve vaccinated everyone. We’ve done it. And in record time.

But wait, not the same people, you say.
Oct 19, 2020 • 5 tweets • 2 min read
The lack of performance delivery/enforcement clauses for the outsourcers’ and management consultants’ abysmal performance of their roles in the Test And Trace programme has been getting some new attention this week. @HSJnews readers know that I wrote about these issues a month ago, linking to and quoting those contracts. hsj.co.uk/policy-and-reg…
Oct 19, 2020 • 5 tweets • 1 min read
The Cummings-Johnson government is led by campaigners (Mr Dominic Cummings) and former journalists (Mr Boris Johnson and Mr Michael Gove): these are people whose career-fundamental belief is that you can “comms” big, real problems away. .@HSJnews readers know that you cannot “comms” big, real problems away. They have watched past attempts to do that fail, often with disastrous consequences for patient safety and care quality.
Oct 19, 2020 • 5 tweets • 1 min read
Conservative peer, NHS Improvement chair and TAT leader the noble Baroness Harding of Winscombe gave the Sunday Times an interview, in which she laments that “everyone wants to believe that test and trace is a silver bullet. It has never been and it never will be”. Life comes at you fast, eh?

Dido’s lament is a long way from M*tt H*nc*ck’s statement on 23 April that “This test, track and trace will be vital to stop a second peak of the virus”.

And an equally long way from the PM’s “world-beating” system promised five months ago in May.
Oct 19, 2020 • 6 tweets • 1 min read
In the least surprising event of this week, the Test And Trace system which is essential to getting the current Second Cummings Wave under some sort of control once again returned dismal performance figures. The latest data show that just 62 per cent of contacts of those infected are reached by this programme. Regular readers know that this needs to be over 80 per cent to make the programme effective.
Oct 19, 2020 • 6 tweets • 1 min read
This week saw prime minister Johnson announce a new three-tier local alert system, with different rules in the medium (Tier One), high (Tier Two) and very high (Tier Three) alert localities. “But hang on!” I hear you ask, “what happened to the government’s covid-19 Five Alert Levels? You know, the Nandos scale one?’
Oct 16, 2020 • 4 tweets • 1 min read
If we had a not-shit national media, their first question would be to ask the precise date (month and year) on which these tests will be validated and rolled out. I'm not really holding my breath, tbh.
Oct 16, 2020 • 4 tweets • 1 min read
Ah. The government is going to hand out fictional tests to read that go into higher tiers. These tests do not actually exist.
Oct 16, 2020 • 4 tweets • 1 min read
Interesting editorial from @TheEconomist comes out against a national lockdown. economist.com/leaders/2020/1… Three things strike me about it. The first is that they have not even attempted to quantify a ballpark cost of a 2-3 week restriction on economic activity. The second is that they haven't done the same cost calculation for the health and care system getting badly overwhelmed.
Sep 17, 2020 • 8 tweets • 2 min read
It seems @stellacreasy asked Mr H*nc*ck about penalties for non-performance in the private sector Covid testing contractors theguardian.com/politics/live/…. I covered that in my latest column: there are no penalties. That's written into those contracts. hsj.co.uk/policy-and-reg… "The Contractsfinder website has put up the Sitel contract for contact centres (worth £84m), as well as Serco’s, for £108m.

Both of these huge contracts have the following clauses regarding non-performance:
Apr 29, 2020 • 15 tweets • 2 min read
The new national guidance is out, and available here. A few quick thoughts. 1/x These are the logistical nuts and bolts. Alongside them, we need to ask ourselves what kind of system we want to make next. In other words, what kind of a system would we like to use.
Mar 13, 2020 • 19 tweets • 3 min read
I'm not a virologist or an epidemiologist. I'm a journalist, so I watch what people in charge of the politics and management of the NHS do, and I try to work out why. Then I try to explain it.