The Week

The Week, 24 February 2023

Patrick King
Senior Researcher

With Parliament back from recess, Labour leader Keir Starmer was quick off the blocks in setting out five “national missions” that will underpin his party’s next manifesto. While at Reform HQ we’re big believers in mission-led government — which can support cross-departmental working and improved focus on delivery — as others have been quick to point out, detail matters, both for tracking progress against outcomes and holding government effectively to account. As Labour’s supporting document says, a strong mission needs “measurable outcomes where it is clear what success looks like”. Reform looks forward to seeing this fine print.

On the Government side, on the theme of health, we had an announcement and a leak. For the former, Lord O’Shaughnessy will be leading an independent review into the UK’s commercial clinical trials landscape. For the latter, health chiefs have reportedly been pressuring Treasury for an NHS workforce plan (due next month) which doubles the number of medical school places.

Firstly, the O’Shaughnessy review. As the experience of the pandemic and Vaccines Taskforce showed, the UK is a genuine world leader in life sciences. But, as a Reform report highlighted last December, to retain this position, there are critical barriers to innovation we must address. Clinical trials are a key example of this, with the Government’s press release citing a 44% fall in the recruitment of patients to commercial clinical trials between 2017 and 2021, and a 41% drop in the number of trials initiated.

Some of the challenges in this area are well rehearsed — it is often difficult to recruit clinicians to carry out these trials, for example, as well as diverse enough patients to ensure new drugs don’t exacerbate health inequalities. But given how vital clinical trials are to attracting investment in the life sciences, and so to broader economic growth, identifying some of the practical steps we could take in this area is hugely welcome. Interestingly, over in the US this week, it was announced that the Food and Drug Administration (FDA) will soon require companies to submit plans to ensure the diversity of participants in late-stage clinical trials. As the UK reviews its own approach to clinical trials, some potential learnings from across the pond.

Second, the workforce plan leak. It’s no secret that there are big vacancies in the NHS, and that a growing number of junior doctors in particular are now considering working abroad or leaving the profession altogether. In this context, in addition to retention, it is right to think about who’ll be entering the future medical workforce.

At the same time, we know that the highest vacancy rates exist in the community workforce, social care and mental health care, rather than specialist or acute care — as we pointed out in our recent paper on what’s actually going on in A&E. In doubling the number of medical school places, we risk baking in existing system failures, rather than addressing shortages in the areas we need them most. Particularly those that keep people in good health, and out of hospital.

If the workforce plan does include a “radical overhaul of training” as rumoured, it should be centred on the healthcare system we want to see — one capable of treating more people out of hospitals, responsive to a growing burden of multimorbidity and poor mental health, and crucially, one that’s substantially more preventative and that creates good health.

Onto the reads…

First up, is this report from our friends at the King’s Fund on end-of-life care. Research in this area never makes for cheery reading. But given that (alongside taxes) death is inescapable, that our preferences on how we want to die are changing rapidly, and end-of-life care can be extraordinarily and unnecessarily costly, we ought to focus much more on it. The report makes clear that while more of us wish to die in the comfort of our own home, the system hasn’t caught up to facilitate this. A familiar litany of solutions is offered — better join-up between the NHS and social care, more data on the quality of end-of-life care, and co-producing plans with patients, carers and families. That’s not ground-breaking stuff, but getting the basics right can help people die well.

Second, a piece in the FT by Siva Anandaciva on variation in NHS performance. This is a subject that is finally getting the attention it deserves. Despite our claims to have a ‘national’ health service, performance varies widely between regions and trusts. Anandaciva looks at A&E performance and notes that there is a 46 percentage point gap between the highest and lowest performing departments in the country when it comes to seeing patients within four hours. He makes some welcome points about the need to do more to attract top leadership to struggling organisations and the need to pool resources between trusts to meet operational challenges. Going further, we should also better use data on unwarranted variation to find unexpectedly high and low performers and draw useful policy lessons from their approaches — see this handy thread from our health lead Seb Rees.