The Week

The Week, 27 January 2023

Sebastian Rees
Senior Researcher

Forgive the slightly longer edition this week, but we wanted to give you a mini summary of today’s speech by the Chancellor, as well as our usual pull out from the past 7 days.

Today the Chancellor gave his first, non-fiscal statement, speech, setting out the Government’s plan for growth ("necessitated, energised and made possible by Brexit”). It’s actually an encouraging-ish read, though a lot of heavy lifting to do by way of detail in the upcoming Budget.

The plan has four pillars: “Enterprise, Education, Employment and Everywhere”. To stimulate entrepreneurship (did you know Hunt had set up his own business?), we need competitive taxation, more risk taking, smarter regulation, and easier access to capital. That’s the first ‘E’ covered. Always good to hear some truisms.

On the second ‘E’, Education, the Chancellor told us we need to do more for the 50% who don't go to university — Sir Michael Barber, of delivery fame, is on the case: “advising the government on further improvements to the implementation of our reform agenda”. May we suggest a more ambitious agenda for future-proofing education and skills might be needed?

Next up, Employment. The Chancellor told us that “Excluding students [those economically inactive] amounts to 6.6 million people — an enormous and shocking waste of talent and potential.” Amen. “It is time for a fundamental programme of reforms to support people with long-term conditions or mental illness to overcome the barriers and prejudices that prevent them working.” Double amen. This is essential to UK productivity, prosperity and wellbeing, and is something Reform has been calling for for years.

Finally, Everywhere. Yup, it’s Levelling Up. “If our second cities were the productive powerhouses we see in the other major countries, our GDP would be nearly 5% higher”. It’s about physical and digital capability and investment zones ("mini-Canary Wharfs”). Interestingly, it’s also about devo: “civic entrepreneurs [must have the] ability to find and fund their own solutions without having to bang down a Whitehall door”. And, intriguingly from a Treasury voice, “we need to move more decisively towards fiscal devolution”. Now that really would be welcome (albeit v complicated).

Earlier in the week…

The so-called ‘death’ of Levelling Up has been a theme for think pieces in recent months. And with 3 PMs, multiple cabinet reshuffles and crises engulfing public services, the Government’s attention has been elsewhere. But Levelling Up secretary Michael Gove re-affirmed the Government’s commitment to the “moral purpose” of Levelling Up in a speech to the annual Convention of the North this week. He also announced new "development corporations" in the North East, and floated the potential of devolution in Cumbria and the North West.

At the same conference, Labour set out plans of its own to make devolution work. The shadow Levelling Up secretary Lisa Nandy, announced Labour’s support for devolved public accounts-style committees to hold local leaders to account for spending decisions. These would mirror the structure of the effective parliamentary Public Accounts Committee in Westminster. As always, the success of this proposal would hinge on effective implementation, but more transparency over sub-national spending is vital to improving services and ultimately the functioning of democracy at a local level.

In health news, on Tuesday, the health secretary took policy watchers by surprise by announcing the Government would set out a unifying ‘Major Conditions Strategy’. That’s a big break from the norm — usually health strategies focus on specific conditions or cohorts (a plan for dementia, or a plan for young people’s health). And there’s a risk that an all-encompassing strategy might dilute focus on conditions where improvement is sorely needed — cancer, for instance, where survival rates in the UK are far lower than in comparable nations.

However, this new strategy shouldn’t be dismissed as government lightening its workload. The most pressing challenge our health system faces is not the burden of single diseases but how to address the huge number of patients living with multiple long-term conditions — so-called multimorbidity. It is estimated that by 2035, the proportion of people living with 4 or more diseases will almost double to 17% and our current approach to healthcare, centred on specialist care for individual conditions, is not suited to this new reality. A strategy that recognises the specificities of individual conditions whilst acknowledging the need for a more holistic approach may be exactly what the doctor ordered.


On to the reads…

First up, this report from our friends at the British Academy and Power to Change sets out the findings of their year long project on strengthening Britain’s social infrastructure. At Reform, we passionately believe that vibrant and supportive communities are essential to promoting our collective wellbeing and to the functioning of both the State and market. There’s some important ideas here, not least the attention given to the role of the private sector in contributing to the social fabric of places. It’s too often assumed that the public and voluntary sectors should do the bulk of the heavy lifting when it comes to revitalising communities, but as employers, investors and owners, businesses must play their part too.

Second up this week is the Archbishops’ Commission on the future of social care’s National Care Covenant for England. The commission calls for a fundamental shift in the debate — we need to stop thinking of care as an appendage to the NHS and start thinking of it as an investment to allow people to “flourish and live life to the full”. Great start!

However, as always the challenge here is financial. To achieve the goals set out by the Commission — a universal care ‘offer’, immediate support to local authorities, and better conditions for carers — means stumping up cash, and that’s particularly hard to do at the moment. The solution offered (an increase in taxation), can’t be the sole answer, not least because of a harsh demographic reality — a declining working-age population needing to foot the bill for a growing older population. We need a serious debate about the future of our creaking care system, but alternate funding options need to be on the table to make reform a realistic prospect.