The Week, 10 February 2023
It's been an interesting, if slightly odd week in politics. On Tuesday, Rishi Sunak launched a surprise Cabinet reshuffle, based on a machinery of government reorg, in which he managed not to sack anyone.
So, what to make of Sunak’s reshuffle? To recap: the Department for Digital, Culture, Media and Sport (DMCS) became CMS (dropping digital), while BEIS was split into three: a new Department for Energy Security and Net Zero (DESZN), a partial merger with DIT to create the Department for Business and Trade (DBT), and a Department for Science, Innovation and Technology (DSIT) which picks up the digital brief from DCMS. In other words, out with BEIS, DIT and DCMS, in with CMS, DSIT, DESNZ and DBT.
Broadly speaking, these are pretty sensible changes. Digital, despite being fundamental to just about every aspect of life, has always sat rather awkwardly within DCMS. Moving this agenda into a new department that can properly focus on the huge opportunities presented by science and tech is smart. BEIS has long been criticised as ineffectual, and, unsurprisingly given the current energy crisis, the ‘E’ has come to dominate. Creating a department focused solely on energy security and net zero — two vast, multi-decade priorities — is eminently reasonable.
That’s the plus — but it also raises questions. Apart from the obvious — the major upheaval caused by departmental changes — it all means a further expansion of Cabinet. We now have 18 Secretaries of State, plus a handful of other briefs that come with Cabinet attendance, way more than any best practice would suggest makes for an effective decision-making body.
In addition, more departments means more Whitehall fiefdoms, when what we need is cross-government working. Developing the right structures to coordinate action — often Cabinet Committees, though Churchill briefly appointed overlord ministers — is essential for tackling the kinds of strategic challenges that transcend departmental boundaries. Is it time for more Cabinet Committees or, more radically, a two-tier Cabinet? Or perhaps we need to bring back the overlords… We’ll leave that question open for now.
Elsewhere, there were two major reports on mental health and wellbeing this week. First up, a new NAO report took a deep dive into NHS England’s work to improve mental health services. It finds that staff numbers and funding have both increased overall, but lengthy waiting lists persist in too many places. Part of this seems to be a lack of concrete planning, with the NAO suggesting that the goal of achieving ‘parity of esteem’ with physical health remains undefined, but other common NHS issues are present here too — from retention challenges (13% of the NHS mental health workforce quit in 2021-2022), to a failure to build up community-based services.
A more mixed assessment comes in this DfE report looking at children and young people’s wellbeing throughout the 2021-2022 academic year. The headline finding is an “inconsistent recovery of children and young people’s mental and physical health” post-pandemic, with progress on metrics like physical activity, while other areas (such as likely mental health disorders) remain higher than pre-2020.
And onto the reads…
Our first read is from our friends at the IFS, who on Monday published a report proposing reforms to the way that pensions are currently taxed. They highlight that the 25% tax free lump sum pensioners can take on retirement is disproportionately generous to those on higher incomes. To tackle this, the fiscal gurus are proposing capping the 25% tax free component to the first £400,000 of accumulated pension wealth. This, they say, would make pension savings more equitable and more economically efficient — increasing government revenue by £15 billion a year.
Our next read is a report from the Public Accounts Committee, which takes stock of early evidence emerging from the introduction of Integrated Care Systems (ICSs): almost exactly a year on from the Government’s own Integration White Paper. Back then, the White Paper was clear, and right to say, that the litmus test for ICSs would be how they deliver for patients. So it’s pretty alarming that the opening verdict of the report is that it’s “not clear what tangible benefits for patients will arise from the move to ICSs” nor “by how much or when”. Hammering home the point, it calls on DHSC to set out “What specific measurable benefits it expects from the formal move to ICSs”, “including the timeframe for achieving them”.
We’ve long had our own reservations about ICSs. For example, how they’ll be held accountable for effective joint working between the NHS and local government, particularly since ICSs are primarily answerable to NHS England, not local areas (which often have misaligned incentives). The report by PAC similarly worries that as “oversight of ICSs largely focuses of NHS elements”, “the wider system is being overlooked”. Amen. It goes on to say that a focus on short-term challenges, “such as elective care backlogs and A&E waiting times” (although rightly a current priority for the healthcare system), has come at the expense of the ICSs’ fulfilling their long-term, stated aims of “prevention”, and “addressing the causes of ill-health”. More reasons to note the date of Patricia Hewitt’s review of ICSs in March!