The Week

The Week 10 November 2023

India Woodward
Senior Events and Fundraising Officer

This week, the Reform team gathered to watch the King deliver his first speech to open Parliament. An event dripping with traditional formalities and gorgeous British pageantry was fitting for what the speech was: a formality, with few surprises.

In the year before an election, with a well-positioned opposition, this was a rather thin King’s speech, with the lowest number of bills (21) since 2014 and a worrying lack of legislation to address our crumbling public services.

One major theme emerging from the speech is an effort to crack down” on crime. There will be new powers for police “to enter a premises without a warrant to seize stolen goods, such as phones, when they have reasonable proof that a specific stolen item is inside a property or premises”. Previously, this has been a frustration for police (explained neatly by this tweet), considering GPS technology can quite accurately confirm the location of a person’s stolen phone.

Also part of the speech is the promise of new sentencing laws keeping those who commit certain crimes (including rape and sadistic murder) behind bars for longer, or even for life. With incredibly strained capacity in prisons across the UK — prisoners are already being released early to ease overcrowding — how are they squaring this? Well, one method will be the introduction of a presumption against any sentences of 12 months or less, and more use of home detention approaches for sentences under four years. This will certainly create more space in the system, but these are also controversial proposals to have been framed as part of a new “tougher” approach. As ever, government policy means trade-offs, shaped and constrained by the capacity of the state.

The nod towards the NHS workforce plan, while welcome, does not go far enough, and there was a gaping hole where legislation for NHS reform should have been. The only health-related legislation that cut through was the pre-announced smoking ban whereby the age of sale is increased from 18, by one year, every year until no one can buy a tobacco, recommended by the Khan Review in 2022.

At Reform we are all about prevention, and this is definitely a move in the direction of the kind of long-term thinking that could help to divert pressure from the NHS. Questions remain about how this ban will be enforced and the peculiar circumstances that will arise: will 40-year-olds be buying packs of cigarettes for their 39-year-old friends? Regardless, we endorse efforts to tackle unhealthy behaviours that cost the NHS and the taxpayer.

Overall? Not much to write home about. Reform will be waiting (im)patiently for the Autumn Statement in a few weeks’ time.

Onto the read of the week…

The King’s Fund this week published a report reflecting on the progress of NHS trusts to take a more “inclusive approach” to addressing waiting lists — a response to the significant inequalities laid bare by the pandemic. According to the report, in August 2022 “people who live in the most deprived parts of England were 2.1 times more likely to wait over a year for elective treatment than people who live in the most affluent areas”.

Some trusts have clearly taken this challenge seriously, such as University Hospitals of Leicester Trust who now analyse attendance rates for inequalities linked to deprivation, among other factors, and target additional support to address this. But such efforts appear to be the exception: overall, trusts’ response was patchy.

Shifting responsibility to the local level to address waiting list inequalities offers trusts the freedom to provide bespoke solutions — prudent, when the exact causes and consequences of health inequalities differ from place to place. However, the report reflects that the lack of a distinct national message on the ‘who’, ‘what’, ‘why’, and ‘how’ has translated into a lack of widespread change. For example, avoiding confronting how exactly deprivation and ethnicity should be incorporated into waiting list prioritisation leaves a lot of sticky questions in the hands of individual trusts. The report calls on government to push for a clear, national agenda in this space and we at Reform agree.