The Week

The Week 2 February 2024

Charlotte Pickles

The biggest news this week was the return of the Northern Ireland executive, after two years — timed perfectly to coincide with the joint Reform/Deloitte publication of 'State of the State 2024: Northern Ireland'.

The senior civil servant who told us “There has been a loss of momentum without Ministers” will be relieved, but based on the view of one politician who said “if the Executive returns it is likely to be very fragile,” we'd suggest cautious optimism.

If you want to know more about what the returning Executive has to grapple with, and what the public expect, do give the report a read (and ignore the politician who suggested “the reform fairy can’t magically appear and fix things” — we're pretty sure reform will indeed have to play a central role in fixing public services).

In Westminster news, the Government announced two welcome health policies: an extension of their Pharmacy First initiative and a ban for disposable vapes.

The former is aimed at alleviating pressure on over-stretched GPs, and means we can head to our local pharmacy to access treatment for seven “common conditions”. As Dr Claire Fuller, NHS England's medical director for primary care, and author of the compelling 2022 Fuller Review, rightly points out, this is very good news for patients: "We all live increasingly busy lives, and this gives people more options on how and where they access care”.

At Reform we strongly believe primary care is in need of a rethink (and we'll shortly be launching work to do just that). This sort of initiative, which disrupts the largely unreformed GP model, is a good start.

We do have one note of caution, however. Concerns have been raised about pharmacists prescribing antibiotics. As regular readers of The Week will know, Reform has written extensively about the threat posed by antimicrobial resistance (for example here and here and here) and the over-prescribing of antibiotics is a very real problem. NHS England has promised continuous scrutiny. This is absolutely key, any initiative that exacerbates the threat of AMR would be a highly regressive step.

On to the vape announcement. Predictably, this has triggered the anti-nanny state-ers (see also the proposed smoking ban), despite the fact that the move is aimed at stopping the rise in child smokers — which presumably we can all agree is not ideal. CMO Chris Whitty puts it bluntly “Stillbirths, cancer, asthma, dementia, stroke and heart failure — smoking causes disability and death”, and the health secretary has helpfully pointed out that smoking is the largest preventable cause of death in England.

Which all also means that smoking places a massive burden on the NHS…and therefore the public purse (taxes being something a lot of anti-nanny state-ers are also pretty down on). Personally, I'm happy to give up my right to buy a bubble-gum flavoured vape if it means I can actually access healthcare when I need it.

What we've been reading…

Our read of the week comes from the the Levelling Up, Housing and Communities Committee. Yesterday the Commons committee published their report on Financial Distress in Local Authorities, calling on government to “help bridge the £4 billion funding gap”, but also, crucially, to find a long-term solution to address the “broken” funding model.

Citing in particular the rising, high-cost demand driven by children's and adult's social care, SEND, and homelessness, the Committee states: “The Government elected after the next UK General Election, regardless of their political persuasion, must embark on a fundamental review of the systems of local authority funding, local taxation, and delivery of social care services.”

Reforming the “regressive” council tax model, “wider fiscal devolution” and “fundamental reform of funding and delivery of social care services” are all things we at Reform can — and will — get behind. Watch this space for upcoming Reform research on exactly this topic.