The Week

The Week, 24 August 2018

This week, UK and Scottish public finances data showed that Scotland is running a much higher deficit as a proportion of GDP. One day, following the ideas of the Barber Review, these figures will also explain what UK and Scottish citizens are getting for the money, and how it could be better spent.

Andrew Haldenby, Director

Reformer of the week

John Appleby, who set out the balanced view on the role of competition in the NHS in a review on Wednesday.

Good week

Balanced commentary on competition in the private sector I

On Wednesday, John Appleby argued that contrary to the sense of the political debate, NHS funding for private providers fell in 2017-18 as a proportion of the overall budget. He said that, ”discussions on the role of the private sector may have become so loaded that they were now obscuring sensible debate”.

Balanced commentary II

On Monday, the Ministry of Justice took over the management of G4S-run Birmingham Prison for a six-month period. Commentators argued that the decision was due to factors affecting the whole prison estate rather than to outsourcing. The Ministry has made three such interventions in the last year. The previous two were in regard to public sector-run prisons.

Unwarranted variation in NHS care

On Friday, Sir David Dalton argued that grouping NHS hospitals into chains would lead to more uniform, higher standards.

Long-term health costs

On Monday and Tuesday, a number of articles showed how improvements in care for diabetes and other diseases could prevent future ill-health for patients, easing the pressure on NHS finances.


“As an economist, the thing I care about and I think other people should care about is not, ideologically, ‘who owns the means of production?’ but ‘is owning the means of production important in terms of the volume and quality of patient care and the efficiency with which it’s delivered?’”. Some worry about private companies taking profits out of the NHS, but Prof Appleby said: “Just because that happens doesn’t necessarily mean it’s a bad thing because, as we know, profits may be the incentive to actually lower costs and provide a really efficient service. That’s a premium you might pay, but in some cases it could be a better use of money.”

John Appleby, chief economist of the Nuffield Trust, speaking on Wednesday

“Salford’s success raises the question: why can’t other places do what we have? One reason is surely that there are simply too many separate hospital trusts, each trying to invent ‘best practice’. England has 135 separate acute trusts, each with their own separate boards, each able to determine how they provide services, each with its own organisational interest. These separate fiefdoms, with 135 different ways of doing things, are a key reason why standards in care vary so dramatically in what is meant to be a national health service.”

Sir David Dalton, CEO, Salford Royal NHS Foundation Trust and Member, Reform Advisory Board, written on Friday

Reform’s Week

Reformer Blog

On Monday, Dr Louise Bennett, Co-Chair of the Privacy and Consumer Advisory Group, wrote a blog on making public sector services fit for the 21st century using data sharing.

Also on Monday, Neill Crump, Chief Data Officer, Worcestershire Office of Data Analytics (WODA) authored a blog highlighting the importance of data sharing in achieving integrated services.

On Tuesday, Rabia Khan PHD MBA, Founder of Stealth Mode, wrote a blog as part of our blockchain series, on the potential for blockchain to share healthcare data safely and securely.