The Week

The Week, 14 January 2022

Listening to the headlines this week, you’d be forgiven for thinking there was no news other than that related to No10 garden parties, Novak Djokovic’s visa status and Prince Andrew’s royal titles. Not so. Here’s what you need to know from a pretty busy policy week in Whitehall...

On Thursday, NHS England released its latest waiting list figures. Yet again, the numbers are bleak — in November 2021 the waitlist hit 6 million, a 50% increase on pre-pandemic levels. 18,500 of those patients have now waited more than two years for treatment, a new category recently added to the data because the delays to care are so severe. Disturbingly, NHS England appears to have buried this most worrying data, hiding the relevant columns in the spreadsheet. To give you a sense of how bad things are, current trends show the number waiting more than two years is doubling every three months. And this data is pre-Omicron, which we know led to further cancellation of elective procedures.

Maintaining business as usual in the face of pandemic pressures remains a priority for our health system and this week, the Health Secretary announced a COVID surge deal with the independent sector to put staff and facilities on standby to support the NHS. At Reform we’ve long argued that getting on top of spiralling waitlists requires using the independent sector effectively, but Javid was forced to give a ministerial direction (i.e. a sort of override of civil service advice) due to value for money concerns. The terms of the deal involve independent sector providers being given a minimum income guarantee, meaning they could be paid large sums (up to £90 million a month) even if no activity is delivered. As Sir Geoffrey Clifton Brown noted at a Public Accounts Committee hearing on Wednesday, “That sounds like a very expensive insurance policy”.

And that’s true. However, as ever, it’s not that simple. Independent providers are essentially being asked to keep resources available for NHS use, which places a limit on their usual work. Fair compensation for this is only right. But given the size of the waitlist, it’s hard to see how the NHS could justify leaving that capacity idle. To ensure value for money, the Secretary of State must require NHS trusts and Integrated Care Systems to publicly account for how they will use independent provision, and use data must be published.

Speaking of accountable spending, on Tuesday, our friends at the Institute for Fiscal Studies published research on local government finances during the pandemic. The top line: local authorities significantly over-estimated the impacts of COVID-19 on their expenditure and were therefore “over-compensated” by central government, allowing councils to build up billions of pounds in reserves. Given their long-standing financial difficulties, that sounds like good news for local government. But it calls into question their ability to accurately forecast expenditure — big over-estimates may lead to a ‘boy who cried wolf’ scenario, damaging councils’ ability to negotiate with the centre. More importantly, with such significant strain on council budgets, it’s alarming that taxpayer money is being banked rather than spent on alleviating need in our communities. Let’s hope councils have plans to make sure the cash gets to where it is needed most...

Speaking of cost-pressures on local authorities, on what’s been a particularly distracting news week, the Government slipped out its impact assessment on the social care reforms announced last year. We must confess that at 139 pages we haven’t had a chance to look through the fine print — we’ll get back to you when we have! What stands out already is that the ‘market-shaping’ role of local authorities in securing a “fair cost of care” for self-funders will continue to cause headaches and big costs likely lie ahead. Watch this space!

Here’s what we’d recommend reading this weekend...

First up, this piece by Helen Lewis in The Atlantic on the effect of two years of lockdowns and restrictions echoes what many of us seem to be feeling at the moment. We’re only just starting to come to terms with the huge psychological toll this pandemic has taken on all of us and Lewis captures the anxieties and losses that many are feeling perfectly. This line, in particular resonated with us at all at Reform: “I got my vaccines the minute I was allowed to. I wear a mask whenever doing so is mandated. But I’m done, profoundly done.”

Secondly, Simon Ruda’s reflections on the future of ‘nudging’ and behavioural insights in the public sector is a must read from UnHerd this week. Simon notes that while ‘nudging’ campaigns have had a big impact in the last decade and have enormous positive potential, during the pandemic, nudging had gone too far, particularly due to “the level of fear willingly conveyed on the public”. As above, high levels of anxiety, fear and distorted perceptions of risk will be with us for some time to come, and will make important conversations about trade-offs in policy even more difficult to have (see some of the responses to Helen Lewis’ perfectly reasonable article).

Finally, a more positive read: this polling from the National Lottery’s Community Fund finds that three quarters of people in the UK feel part of their local community and that number is growing year on year. Particularly promising is the fact that young people are leading the way — 18-24 year olds are more likely to feel connected to their community, more likely to see this as important and more likely to volunteer or help out in 2022 than in the previous year. Harnessing this energy and sense of connection should be a priority for policy makers in the post-pandemic world!