In conducting the review of Health spending the new Secretary of state needs to pursue some of these questions.

1. How much will the planned reorganisation cost?  What is the purpose of the abolition of Clinical Commissioning Groups and their replacement by Integrated Care Boards and Integrated Care Partnerships ? Will some  of the CEOs of the CCGs be appointed to be CEOs of the  new bodies?  Will they still be paid some redundancy payments or is there a clause which says if they maintain employment with the NHS there should  be no such payment? If the NHS decides to appoint former CEO employees in the reorganisation does it save headhunting and recruitment fees on those people? Are there planned savings from the reorganisation, and if so how much and when?
2. Test and Trace. Test and Trace understandably was expensive in its first year when there were a lot of set up costs and provision of a large capacity in the face of an unabated pandemic. Current year spending of £15bn on T and T seems high. Surely next year there can  be a sharp reduction in T and T spending, with much of the cost now sunk, and with less need for capacity to man the system which can be  largely automated anyway.
3. What are the forecast costs of the  vaccine programme against CV 19 going forward? Again surely there will  be substantial savings next year as most people who want to be vaccinated will have had two jabs and many will have had a winter booster as well?
4. How much will be saved by not hiring in capacity from the private sector in the way the NHS did during the peak of the pandemic? How many treatments and operations will the private sector carry out for people willing to pay, relieving pressure on the NHS as private capacity is returned to that sector?
5. What productivity savings are brought by the use of digital consultations and remote medicine?

I was a participant this evening on The Clash. The full video is available here:

I am publishing tomorrow’s blog now, as the Health Secretary has just spoken to Conference and this provides some of the relevant detailed background for those writing about it.

In response to those of us who have asked how the new Secretary of State will ensure the extra money directed to the NHS will be used to raise the quality of care, improve access and get the waiting lists down, Mr Javid has announced a review of NHS and Care  leadership.

He has appointed General Sir Gordon Messenger and Dame Linda Pollard to conduct a review into how efficiency and innovation can be improved in the NHS and how regional inequalities can be reduced. As Health now has a massive £230 bn budget, absorbing all of our Income tax, CGT, Inheritance tax and Stamp Duty it is indeed to time to review how it can be better spent and to ask what another £12 bn can  bring that £230 bn cannot achieve. I wish to explore this in a few pieces and pass on my thoughts to the Secretary of State. I would have preferred the terms of the review to have been more narrowly focussed on quality and cost of care.

Let us begin by asking what can we expect of the two lead characters appointed?  I wish them both well and acknowledge they have had successful careers in public service. May they be wise and insightful in this task, stepping outside the frequent public sector wish to claim all is well and turn most arguments into one about how much extra money is required .Often the need is  to remedy defects in the way the base  budgets are spent.

General Sir Gordon can draw on the talents, bravery and discipline our soldiers show, and their ability to improvise and respond quickly when on active service. He was decorated for his personal bravery in leading troops in action. I hope he has also learned from some of the failings of MOD and senior army management. There is a long history of big budget overruns and delays when buying equipment. The use of the rank of Lieutenant Colonel paying around £80,000 a year for 1510  senior officers in a service of 82,000 armed personnel  does not look like slim management. There are 590 more  officers of ranks above Lieutenant Colonel  to fill the main national management roles.

Dame Linda Pollard can draw on the example of the bravery, hard work and versatility shown by the front line NHS workers handling serious covid cases over the last year and a half. The Leeds Teaching Hospital she chairs  was last rated as  Good by the Care Quality Commission. It did, however, receive criticism for safety which needed improvement. It failed to meet performance standards for referrals to treatment – i.e. too many people waited too long. Its emergency readmission rates were above the national average meaning more remedial treatments were needed. Its staff cost per unit of work were lower than average but its non staff costs higher. I would be more reassured about her advice were Leeds to have an outstanding rating for safety and quality of care, and were it not to have issues in getting waiting lists down.

The media did not seem to report any of this, saying the review was an attack on waste and wokery. It is not quite what the announcement says. I do think the Secretary of State needs to sit down urgently with the leading CEOs running the NHS in England to get them to identify what they need to do to get waiting lists down, the prime current objective. Of course this also entails performance criteria for quality of treatment and cost. His own performance monitoring system which is very detailed by CQC should help him decide which of the senior CEOs are  good, which need to be mentored to improve  and which if any need to be removed for continuing poor results.

It is true NHS spending is up by £1200m a week over the last two years, well ahead of £350 m illustration on the side of the Brexit bus as we save on our contributions to the EU.

Its also true we developed and rolled out a new vaccine ahead of the EU approving and importing US vaccines, thanks to the flexibility Brexit provided.

Meanwhile we await more Brexit wins. When will the government abolish VAT on green products like heating controls and insulation which the EU made us tax?

When will they ban industrial trawlers of over 100 metres length to safeguard our fishery and help our domestic  industry?

When will they abolish the Ports Directive and introduce our new Freeport’s?

When will they restore the Merchant Shipping Act struck down by the European Court to help rebuild our merchant fleet?

When will we get a new Agriculture policy which redirects subsidies to stimulating more domestic food production?

There are many more Brexit wins which the government should bring forward. I spoke about these yesterday.

The stage is set for a post Covid recovery. Adopting a Conservative approach to liberty and prosperity is the best way to promote the greater happiness of the greater number.

Anti pandemic policies damaged incomes and jobs and removed many freedoms. The first task is to restore all our lost freedoms so the quarter of our economy that was effectively closed down can flourish again. The successful vaccination programme should give us the scope to relax, leaving it to each individual to judge how much exposure they want to others given the risks.

The second task is to make the case anew for work as the best means to banish poverty and improve life styles and chances for  families. Conservatives have done more than the socialist inclining parties to advance prosperity, because we recognise it comes primarily from enterprise and effort by  millions of people and hundreds of thousands of businesses.  Markets generate choice and opportunity. Profits reward those who venture their capital and put in their effort, and help pay for the new investment employees and consumers need . Prices fluctuate to  bring forward more supply where needed or to reduce output where the popularity of the product or service is waning. Governments must allow price systems to send their signals.

Markets are not cold impersonal enemies of the many . They are the way we all have choices of what to buy and where to work. All humanity participates in the market. Of course Conservatives believe that the state needs to step in to help those in need, to support the ill and disabled, to prevent monopoly exploitation or market abuse. Conservatives believe in the rule of law to keep people using markets honest. We also know that public sector monopolies that charge customers  also need taming to avoid poor service, high cost and no choice that we used to get from nationalised industries.

The immediate need to is to get some tax rates down. Lets forget the National Insurance rise, the tax on jobs. Lets relax the IR35 rules so they do not stop people developing self employed businesses. Lets take VAT off domestic heating and insulation products.  Lets offer a tax boost to those who will substitute home grown food, home produced gas and home produced timber amongst other things for the large import bills we currently pay and all the extra energy cost of long haul transport.

Let’s help more people on their personal journeys with great education, better training , and easier access to buying a home and setting up your own business.