The Week 3 March 2023
A deal in Northern Ireland and 3 King James bibles worth of government WhatsApp messages to trawl through. It’s been quite the week in Westminster. But, as usual, we’re here to highlight the things you might have missed.
Over the past few weeks, the Reform team has been deep diving into England’s woeful A&E performance. But we haven’t taken our eyes off the NHS’s other core challenge — clearing enormous care backlogs. Quick recap: long waits were growing before the pandemic, but the suspension of non-emergency healthcare in 2020-1 saw them balloon as COVID pressures eased. In December last year, 7.2 million people were waiting for care, with roughly 400,000 of them having waited more than a year.
In February 2022, backed with £14 billion of dedicated funding, the NHS set out a targeted plan for recovery. A year on, and here is the verdict of Public Accounts Committee Chair (and Reform Advisory Board member), Meg Hillier: “The NHS will not achieve the targets in its recovery plan, and that means health, longevity and quality of life indicators will continue to go backwards for the people of this country.” PAC notes that cancer waiting times are at their worst ever level and that the NHS had not met its headline target of eliminating two year waits by July 2022. The problem? Unrealistic assumptions in planning, failures in strategic management by NHS England, and a lack of insight into the core challenge holding back activity — getting patients out of hospital. So, the usual suspects.
Elsewhere this week, the Association of the British Pharmaceutical Industry set out its proposals for a future medicines pricing scheme. This is a highly technical area, but one of great importance. Quite rightly, the NHS is a hard negotiator when it comes to drug prices — the Service spends around £17 billion on medicines a year and getting a fair price is vital for its sustainability. But at the same time, pricing arrangements must be reasonable to medicine producers. Under the current agreement hatched pre-pandemic in 2019, pharmaceutical companies are paying back more than 25% of their revenues (not profit) to the NHS, up from around 5% in 2021.
This huge increase makes the UK a challenging place to do business, and in a country with big life sciences ambitions, should be of major concern. Put simply, unfair arrangements risk the exodus of an industry which is the single biggest private funder of R&D in the UK and adds almost £40 billion to GDP annually.
A different approach is clearly necessary, and the ABPI proposes a fixed annual contribution of 6.88% of revenue. This would put the UK more in line with comparator nations and still net the NHS more than in any year prior to the pandemic. With health services under acute pressure and in search of short term revenue streams, this will be a hard sell, but government must think longer term on this one.
Here's what we've been reading this week...
First up is this piece by Alex Fox and Professor Chris Fox for New Local on ‘How we lost sight of the purpose of public services’. It echoes much of Reform’s thinking on reimagining the state and calls for “radical reform of the organisations that deliver public services”. We can and should be much more ambitious about what public services can achieve and should seek to move our system away from one which simply manages demand and creates dependence, to one which empowers citizens and draws on their strengths and those of their communities. An important contribution to the debate.
Second up is the latest tranche of findings from the Government’s Community Life Survey. The CLS is a treasure trove of data on our social networks, our sense of life satisfaction wellbeing, and our levels of pride in the places we call home. The most alarming findings from the most recent survey are to do with volunteering. Many of us welcomed the big uptick in informal and formal volunteering which took place during the pandemic, and many organisations made recommendations on how to maintain momentum in this space. However, rates of formal and informal volunteering are now at their lowest level since the survey begain in 2013. That’s a real cause for concern given the vital role that volunteers play in supporting the vulnerable, bringing communities together and contributing to personal wellbeing. This is definitely an area for renewed focus.
Finally, while we are still waiting for the month-old Department for Business and Trade to get a website… or, more importantly, a trade minister, Grant Shapps gave his first speech as Secretary of State for Energy Security and Net Zero. There’s nothing really new in there, but he does list 4 priorities: energy independence, lower bills, decarbonisation, and contributing to lowering inflation and boosting growth. And he gained a Minister this week to help him to do that: Amanda Solloway, now Parliamentary Under Secretary for Energy Consumers and Affordability.