The Week

The Year 2021

This is our last The Week of 2021 (our The Year) and we're ending the year with strong December 2020 vibes. We're once again being asked to work from home if we can, wear masks in public places, and get (booster) vaccinated as soon as possible, with the threat of further restrictions in the not too distant future. Even without an actual lockdown on the cards, with cases doubling every two days it's estimated that a million of us could spend Christmas self-isolating.

Throughout the past 18-odd months Reform has consistently argued that the Government needs to take greater account of the trade-offs involved in, and unintended consequences resulting from, measures taken to contain Covid. While there are suggestions that Omicron is milder than previous strains, we really don't yet know what proportion of cases will end up in hospital, but we do know that basic maths tells us a very small proportion of millions of cases is still a big number.

So we're ending the year as we started it, Covid-saturated. But in between there was some, albeit limited, non-Covid policymaking. Here's a quick round-up of the highlights and lowlights for public policy in 2021. Plus our usual recommended reads from the week at the end.

From everyone at Reform, we wish you all a healthy and merry Christmas, see you in 2022...



REFORMER OF THE YEAR: Rt Hon Sajid Javid, Secretary of State for Health and Social Care

Continuing his trend of stepping in after high-profile resignations (DCMS, HO, now DHSC), Sajid Javid took up the mantle as Health and Social Care Secretary in June... and it was immediately clear that he was not there to simply steady the ship. In quick succession, the new Health Secretary unveiled bold plans for tackling growing health disparities, set in train a major review into health and care leadership and vowed to hold managers to account for poor performance. All this alongside attempting to return the health system to business as usual after almost two years of pandemic disruption, meeting the demands of the Omicron variant, and shepherding a major piece of health and care legislation through the Commons. In a year which has seen big funding pledges for the NHS, the Health Secretary's commitment to "significant reforms that make money go a lot further" is one we should all welcome. On ambition alone, Sajid Javid is our reformer of the year.


After a stellar performance last year during which HMT rapidly developed and delivered a radical economic support package, 2021 has seen a reversion to type. We don't mean the increased focus on the need to get back to black — sound public finances are the bedrock of sustainable public services — but the return to short-termist thinking. Rather than coming up with a sustainable funding solution for social care, we have an NI hike, set to become a hypothecated levy, that the Institute for Fiscal Studies say will have to more than double by the end of the decade. A more radical overhaul of business rates was rejected in favour of (some welcome but) largely short-term reforms. Property and capital gains tax reforms also appear to have fallen by the wayside. As has reform of sick pay, despite the pandemic demonstrating the dangers of having an inadequate model. And while the cut to the UC taper rate and increase to earnings disregards was a fantastic Budget move, the Government lacks any real plan for supporting low income families through the current cost of living crisis.


Okay, so we don't like the Government's chosen funding model at all, and we're not convinced by the delivery plan outlined in their White Paper, but we are impressed that they are *actually doing something*. In an article back in late Summer 2019 I wrote: "Successive governments have shamefully kicked the social care can down the road. Will Mr Johnson be the first PM with the backbone to transform the system? ...achieving a fair and sustainable social care settlement would be one hell of a legacy and he may just have the political capital to do it." As we've pointed out, the settlement is neither fair nor sustainable (to avoid sounding like a broken record, see here), but we salute the Government for showing a backbone.

WORST POLICY OF THE YEAR: Integrated Care Systems

Since the NHS's Five Year Forward View in 2014, the move towards 'integrated care' has been held out as a panacea for the woes our health and care systems face. The idea makes sense — given the close links between the two systems and the need to provide care for an ageing population living with complex, chronic conditions. Yet, as is so often the case, things that sound good fail at the point of delivery (normally because the problem has been misunderstood). Research out just this week from the Nuffield Trust looks at the impact of (differing degrees of) integration across the four nations of the UK and finds that it has failed to reduce costs, halt emergency admissions or deliver better outcomes for patients. Ouch! In their words: it "raises important questions about what integrated care can realistically achieve".

And yet from April next year all of England will be organised into Integrated Care Systems with the aim of achieving all those benefits evidence appears to show won't happen. If the mark of success for integration is keeping patients out of acute settings, getting people the support they need in the right place, and tackling the determinants of ill-health, NHS providers (and particularly monolithic trusts!) can't be in the driving seat. Really improving health outcomes will require a critical discussion about how to move away from the hospital dominated system we have towards one that keeps people well, in their homes and communities. Unfortunately, as they stand, Integrated Care Systems don't look like they'll achieve that goal.

SPEECH OF THE YEAR: Dame Kate Bingham, Romanes Lecture

We've had a few good civil service reform speeches this year, including this from Michael Gove, then Chancellor of the Duchy of Lancaster, and this from Simon Case, Cabinet Secretary, but it is Dame Kate Bingham's Romanes Lecture that claims our accolade. Bingham led the hugely successful, and very un-Whitehall, UK Vaccines Taskforce, and uses the lecture to reflect on her experience. She is scathing about civil service skills deficiencies, risk aversion, performance management and the prevailing view that the private sector is full of “money-grabbing fat cats whose only interest is ripping off the taxpayer”. If you're trapped at home self-isolating, or just avoiding the family, the video is well worth a watch.



Disability Green Paper:

Another of the long-promised policy papers, we finally saw the publication of the Government's ideas for improving the welfare system for people with a disability or health condition. For context, over 2.5 million people are in receipt of out-of-work incapacity-related benefits, the disability employment gap is just under 30%, and forecast spend for disability benefits this year is £33 billion. Less than 2% of people on Employment and Support Allowance leave the benefit each month. The green paper seeks views on how to improve the experience of disabled people within the welfare system and how to boost employment outcomes. At the more radical end, redesigning the benefit system itself (which we at Reform have argued is a barrier to better outcomes), the paper is vaguest, but the fact that the Government is asking the question at all is a huge step forward. We have a new Minister for Disabled People since publication in July, let's hope she's willing to be bold.

Prisons White Paper:

The Government’s white paper on Prisons Strategy is the first to be published by the Ministry of Justice in five years. With £3.75 billion allocated to prison building, and an additional £550 million to tackle reoffending, it is backed by serious cash. A new Prison Education Service is particularly welcome — while creating a more sustainable prison estate is, of course, partly about “safe, secure and stable” infrastructure, underinvestment in rehabilitation risks higher long-term costs to the taxpayer, and, ultimately, a less safe society. The Government’s ambition to publish league tables which “shine a light” on prison performance is also welcome, and something Reform called for back in 2016 in our paper Unlocking prison performance, which pioneered a productivity model for prisons. After all, what isn’t measured can’t get done. But they must be used to better understand and improve practice, or else they risk, as the Justice Committee highlighted, making inappropriate comparisons “in a context where there is no consumer”.



Pandemic lesson learning:

There have now been numerous reports published on the lessons Britain must learn from the pandemic — one of the first being our own paper in March, A State of Preparedness: How government can build resilience to civil contingencies — yet the Government itself has said little other than announcing back in May that a public inquiry would be launched, and this week appointing Lady Hallet to chair it. The average time taken to complete a public inquiry is 2.5 years, and the complexity of the response to Covid means it will take far, far longer than that — the next crisis will likely be upon us before we have the results. As we said in our report: "the country cannot afford to wait that long to start putting in place the reforms required to ensure government is better place to respond to future crises." We called for the appointment of a Minister for Resilience and Recovery to lead the process. A recent Lord's committee report called for an Office for Preparedness and Resilience, headed by a Government Chief Risk Officer, to be set up. Whatever the model, the Government needs to take action now.


? And finally, the week's recommended reads...

On Monday, the Survey Centre on American Life published a long-read entitled The college connection: The education divide in American social and community life. As Daniel A. Cox writes, the financial benefits of a college degree are well rehearsed, but the wider social benefits are less discussed. Yet "any analysis that does not take into account the profound social advantages a college education provides is missing a key part of what that education actually offers", namely that key ingredient for a successful life: social capital. Analysis shows that non-college graduates express feeling lonely more often, and have fewer close friends and a smaller social circle than their graduate peers. College graduates also report having more "place-" and "activity-based" friends — with the author pointing out that these "weak ties" often enable employment opportunities. And college graduates are more likely to report having a "third place", a community setting such as a local park or cafe, which they attend.

Also on Monday, Local Trust (full disclosure, I am a Trustee) published their latest essay on community building, written by David Boyle and Steve Wyler: ‘Us and them’: A mindset that has failed our communities. "When we reflect on our country’s recent history", they start, "the first thing that comes into view is that nearly all the effort and resources intended to tackle problems in the poorest communities have been applied through professionalised charities, top-down services, and above all through programmes controlled by governments." Billions have been spent over decades on regeneration projects, but just a tiny fraction of that has gone on community building. The results of this substantial spend have been, the authors report, disappointing. Key to changing the model is moving past the "them and us" mindset that underpins (and is reinforced by) the top-down, tick-box approach. Instead, an asset-based approach is needed, one in which service users and professionals are partners in designing and delivering services, and in which community self-determination is front and centre.