The Week

The Week, 30 September 2022

Sebastian Rees
Senior Researcher

Last week we said the Government was taking a huge gamble with it’s not-so-mini-budget. While very early days, its not been pretty so far — Britain is in the throes of a self-inflicted economic crisis and it will take decisive action to avert a Winter of distress.

There’s cover to cover reporting and commentary on this, so we’re not going to waste your time repeating what others have said, but we do want to stress one point. The Government must not attempt to balance the books by cutting the value of, already very low, benefits. Uprating working-age benefits in line with earnings, not inflation, is indefensible, particularly when it is to cover the cost of cutting tax for high earners. If tough choices on spending lay ahead, this is not one to take.

Public service reform was high on the agenda at Labour Party conference. At Reform, we tuned in closely to the Shadow Health Secretary’s speech on the future of the NHS. Wes Streeting — who will be joining us for an ‘in conversation’ event next month — laid out in refreshingly bold terms the challenge we face: “if we don’t modernise and change the NHS, it will become unsustainable”. Streeting’s recipe for reform? Shifting to prevention, caring in the community, empowering patients and tackling inequalities — all big ticks from us, and very much in line with our recent paper.

But wiley policy watchers will also know that those tend to be the priorities of every Health Secretary (and their Shadow!). We’ll need to hear more from Labour about how they aim to finally tilt the balance in our health system to prioritise creating health rather than treating sickness — and that will require being honest about the trade-offs involved in spending ever more on health care and less on services that create health.

Amazingly, there has been some positive policy news in this otherwise thoroughly depressing week…

First up, the Government announced a new £1.5 billion ‘Help to Heat’ scheme to insulate 130,000 social housing and low-income properties. As we set out in our 10 Graphs for the New PM piece, since 2015 the number of home insulation instalments has been falling, despite a growing recognition that insulation plays a key role in reducing energy use (and costs!) and in turn carbon emissions. There’s still a long way to go in this area — British homes remain among the least insulated in Western Europe. But this is a welcome start — not least given it is targeted at those worst affected by high bills and cold homes.

Secondly, a global clinical trial of an experimental Alzheimer’s treatment, Lecanemab, has found that the drug slows the progression of cognitive decline by 27 per cent compared with a placebo. Alzheimer’s is the most common cause of dementia, a condition that effects nearly one million people in Britain and will almost double in prevalence in the next three decades. That makes effectively supporting people with dementia one of the major challenges facing our health and care system. It’s great to see clinical breakthroughs in this vital area.

Thirdly, Reform is a big believer that a hallmark of good policy is the ability to combine cost effectiveness with better outcomes. Researchers at the University of Edinburgh have found a policy which does just that, in a study on the introduction of 20mph speed limits on Edinburgh’s residential streets. They found simply by using new road signs — rather than extra traffic calming measures or police patrols — collisions fell by 40% in one year, and road deaths fell by a quarter. All for a cost of just £2.76 million. Safer, better for the environment, and cheap to implement. A true triple threat.

We didn't want to end on a negative note, but we couldn't not comment on the (unconfirmed) reports in The Guardian that the Health Secretary, Thérèse Coffey is scrapping the long-awaited Health Inequalities White Paper. This should set alarm bills ringing for anyone who cares about health outcomes or a sustainable NHS or, paging the PM, productivity and thus growth. While white papers aren’t magic bullets when it comes to solving our most long-standing policy challenges (and health inequalities are right up there!), they do set out clear commitments to action. In this area, serious action is desperately needed.

There’s a lot to read above, but here’s one more for your weekend…

At Reform, we’re big believers in the idea that devolving responsibility and resources to those who are closest to the communities they serve is key to improving public services and transforming lives. This piece in The Lancet gives us some hard evidence — in this case, on the health outcomes associated with devolution.

Since signing its devolution deal in 2014, life expectancy in Greater Manchester has been higher than expected in comparison to similar regions and increases in life expectancy have been larger in more deprived areas. The authors acknowledge that “further research is needed to investigate the mechanisms that might have contributed to this effect”, but devolution is almost certainly a piece of the puzzle. Important findings!