The Week

The Week 17 November 2023

Charlotte Pickles

Next Wednesday is the Autumn Statement, but the rabbit came a week and a half early with the appointment of former PM David Cameron as Foreign Secretary.

On Monday, we finally got the long-awaited reshuffle, which, while not as dramatic as it could have been (the Chancellor himself was rumoured to be on the list), was substantial. Half of the ministers at the Department of Health and Social Care are new — including the Secretary of State — and two thirds of the Treasury minsters are new. Four Government departments have a new Secretary of State.

Also on Monday was the even longer-awaited publication of the Maude review into civil service governance and accountability — predictably (intentionally?) buried by the reshuffle. You can read our snap analysis of the contents here. Make what you will of the fact that review publication day was also marked by the exit from Government of the minister charged with responding to it — Jeremy Quin. We will have to wait to see if his replacement, former CST John Glen, will take any of Maude's recommendations forward.

Also this week, head of the NHS, Amanda Pritchard, appeared to deny there was a serious issue with NHS productivity, and, when asked at the Health and Social Care Select Committee specifically about Reform's recent report, stated that it was “odd” that there is interest in follow up waitlists. Jaw drop.

On the former, yes, measuring productivity in the public sector is a complex task, and the approaches we have can indeed be a “blunt” tool. But here's the venerable IFS's verdict: “The NHS has more funding and more staff than pre-pandemic, but the number of patients being treated in hospital has increased by nowhere near the same amount…the available evidence strongly points to the NHS – or, at the very least, NHS hospitals – having an ongoing productivity problem.”

We'll leave you to judge whether being concerned about a 50% increase, to 11 million, in follow-up waits since 2019 — and a total of lack accurate data on waitlist size, duration & treatment function — is “odd”.

But in fact, it was yesterday's 'Back to Work Plan', that is of greatest note this week. Announced by the Chancellor and Secretary of State for Work and Pensions ahead of the Autumn Statement, it is aimed at tackling the ballooning economic inactivity challenge. 2.6 million people are on out of work benefits due to ill-health and disability, almost half a million more than pre-pandemic. Clearly this is a monumental waste of human capital.

Harsher sanctions have taken the headlines, and there's certainly a debate to be had about how effective this approach would be (conditionality is important, but it has to be applied in a way that is actually going to move people into work).

But it is the proposed reforms to 'fit notes', additional investment in personalised support, and increase in access to talking therapies which could make a real difference — and, just as the proposed reforms to the benefits system announced in the Budget did, reflect the recommendations made in 'Working welfare: a radically new approach to sickness and disability benefits' published by Reform in 2016. The Times is reporting that the DWP will employ health professionals directly to undertake assessments and provide treatment. The Government press release lacks this detail, but, if true, this is eminently sensible. We will await further details.