The Week

The Week, 11 February 2022

Health policy wonks have been busy getting to grips with a trio of major announcements this week and a massive NHS data dump. Monday saw the Department of Health and Social Care set out public health grant allocations for the coming year; Tuesday saw the publication of the NHS’s elective backlog recovery plan; on Wednesday we got the long-awaited health and care integration White Paper; and then on Thursday we got the latest waitlist and times stats. Our verdict? Four days of disappointment.

Let’s take each in turn...

For those unfamiliar with public health arrangements, since 2013 local authorities have been responsible for providing a range of public health services, including sexual health checks, drug and alcohol misuse programmes, health visiting and family nursing for 0-5 year olds. In short, they shoulder much of the burden for prevention within the health system. Funding for these services comes from a centrally-allocated, ring-fenced public health grant and pound-for-pound spending on the grant is estimated to be about four times more cost-effective than spending on NHS provided healthcare services. With the Government prioritising early years and tackling health disparities, public health must surely be a clear priority....

Not so. While politicians fall over themselves to promise additional funds for healthcare, public health budgets continue to be squeezed. This week we were told the grant will increase by just 2.7 per cent next year (i.e. below the rate of inflation). This follows on from real-terms per capita cuts of 24 per cent between 2015-6 and 2020-1. If a Government’s true priorities can be seen in their spending allocations, prevention isn't looking so important.

Tuesday’s publication of the NHS’s backlog recovery plan also proved underwhelming. As we pointed out, the targets are decidedly unambitious: 3 years to eliminate year-long waits, and 2 years to ensure that 75 per cent of patients urgently referred by their GP for suspected cancer are diagnosed within 28 days. And its delivery plans to get there are also modest. There are some welcome commitments on increasing diagnostic capacity and moving more of it into the community, as well as the plan to roll out ‘MyPlanned Care’, an online platform providing information and advice to patients on waitlists. But there’s still no plan to tackle the main bottleneck in the system — staff shortages. As the Health and Social Care Committee noted in December “the best-laid plans to increase and sustain capacity in the system will fail unless the system can recruit and retain enough staff with the right mix of skills”. We’re still waiting.

On Wednesday, the Integration White Paper proved a bit of a mess, and you can read our take in full here. Worryingly, it has received almost no attention. As dry as the perennial conversation about health and care integration tends to be, at stake is how to organise a system that spends in excess of £130 billion a year. Proposals put forward this week seem to add more confusing layers of bureaucracy into an already messy system. The White Paper makes little headway when it comes to the core challenge we face — how to move away from an acute-dominated model towards a system focused on building health in communities. It’s here that the greatest opportunities to build a healthier nation lie but where policymakers seem most bereft of ideas.

Finally, on Thursday NHS England published a range of data showing the difficulties our health services face. We’ve long brought you updates on referral to treatment waiting times and these numbers continue to grab the headlines — there are now more than 6 million people waiting for treatment and more than 300,000 have waited more than a year. Data on A&E has been less publicised, but here things are arguably even worse. In January, more than 16,600 people waited in excess of 12 hours in A&E between a decision taken to admit them to the admission actually taking place, a figure that is up by 27 per cent in just a month. And just 75 per cent of people attending A&E were seen within 4 hours — the target is 95%.

So that our health verdicts don’t leave you too gloomy, we have had some positive prison-related news this morning. The Justice Secretary Dominic Raab has announced that prisoners will (finally!) be able to access apprenticeship opportunities. We know that joblessness and poor employment outcomes are a key driver of re-offending, which costs taxpayers a whopping £18 billion a year. Expanding the training and employment support opportunities available to prisoners to maximise their chances of sustainable employment on release is therefore a very welcome move.

Here’s our recommended reads this week...

First up is this briefing by the Children’s Commissioner on the state of mental health services for young people. According to the latest estimates, more than one in six 6-16-year-olds has a probable mental health condition and the life-time costs of poor youth mental health are staggering. The good news from the Children’s Commissioner report: spending on young people’s mental health services continues to grow, more children are being accepted into treatment and wait times are decreasing. The bad news? As a result of big increases in prevalence, we are not getting closer to narrowing the treatment gap (the number of young people with diagnosable need versus the number receiving support).

Second up is this excellent series of interviews with nine former Education Secretaries conducted by Ed Dorrell. It’s a long read but well worth your time. There’s some fascinating insights into the challenges of policy making in this area, but also of ministerial life more broadly. We were particularly struck by Lord Ken Clarke’s description of the three-act life cycle of Cabinet Minister’s: six months of complete ignorance about their policy brief; 18 months of frantic activity; and finally after after two years, the attainment of decent mastery of their subject. If that’s the case, it’s alarming that less than half our Education Secretaries in the last two decades have made it to the two-year mark. Fortunately in that same period, the Department has had much more consistency at the Permanent Secretary level with a number of long-stayers in the top job. Striking the balance between old hands with deep expertise and fresh eyes with cross-Government experience is a long-standing challenge in Whitehall, and this series captures that tensions that exist here very well.