Author Archives: GK Strategy

Sajid Javid- Five priorities of the new Health Secretary

Capital isn’t glamorous, but it’s where health reform succeeds or fails

Drawing on his experience as a Health Minister and Chair of the Health and Social Care Select Committee, GK’s strategic advisor Steve Brine argues the real challenge is delivering, not announcing, NHS infrastructure investment.

There is an old saying in politics that ministers like cutting ribbons more than fixing roofs. Reading the Government’s new 10-Year Capital Plan for Health and Social Care, I was reminded just how true that is.

Having served as a Health Minister and later as chair of the cross-party Health and Social Care Select Committee, I’ve learned that while politicians understandably focus on services, patients and waiting lists, none of those can be credibly improved without investing in the infrastructure that underpins them.

Estates, equipment and digital capability are not simply operational issues; capital isn’t glamorous – but it’s where health reform succeeds or fails

That is why I think this document matters, even if it contains fewer headline announcements than some may have wanted. It’s more of a capital investment framework than a capital spending announcement and while it is important because it starts to join together a series of previously announced commitments into one strategy, if you’re looking for lots of new money or major projects, you’ll likely be disappointed.

For investors, suppliers and those looking to support the transformation of health and care, this is best understood therefore as a statement of strategic direction. The Government is attempting to provide something the NHS has too often lacked: a long-term framework that links capital investment directly to service reform.

The themes will be familiar and re-enforce the view many of us held that the capital plan would essentially be the infrastructure companion to the 10-Year Health Plan which is now just over one year old.

Investment in neighbourhood health centres, modern diagnostic equipment (see my last piece), digital infrastructure, community facilities and the maintenance of the existing estate have all featured in previous announcements.

What is new is the attempt to bring those priorities together and explicitly align them with the Government’s ambition to shift care from hospitals into communities, from analogue to digital, and from sickness towards prevention.

As a minister, I learned very quickly that capital policy is health policy. You can’t expect clinicians to embrace new models of care if they are working in buildings designed before England last won the World Cup, nor can you promise a digital NHS without investing in the infrastructure that powers it. Too often, capital has been treated as something separate from healthcare delivery whereas in reality, it is one of its principal enablers.

That lesson stayed with me when I chaired the Health and Social Care Select Committee. Alongside colleagues on the Public Accounts Committee, we scrutinised the New Hospital Programme, asking not simply whether Boris Johnson’s ambitions were right, but whether they were deliverable.

That experience reinforced a rather obvious point: announcing infrastructure programmes is relatively straightforward; delivering them consistently over a decade, through changing political and economic circumstances, is considerably more challenging!

That is why I think investors should read this document with cautious optimism. The opportunities are clear. If the Government is serious about expanding community-based care, modernising diagnostics, digitising the NHS and addressing the maintenance backlog, there will inevitably be demand for expertise, technology, construction, data, equipment and innovative delivery models.

The direction of travel is now clearer than it has been for some time. The question not answered is pace. The plan sets out the destination far more clearly than the route to get there. There is relatively little detail about sequencing, procurement, prioritisation or delivery milestones.

History also provides a note of caution. During my time in government, I saw how easily capital budgets could come under pressure when day-to-day NHS spending became squeezed. Every government says it will protect long-term investment; not every government manages to do so.

And I note how one of the strongest themes is ‘repair first’ as large sums are earmarked for tackling the maintenance backlog, replacing obsolete equipment and of course removing RAAC. £6.75bn for hospital repairs over nine years and £2bn to remove reinforced autoclaved aerated concrete.

Overall, I see this as a welcome piece of strategic thinking. It provides a clearer signal than we have had for many years that infrastructure is no longer being viewed as an afterthought but as a prerequisite for NHS reform. For those looking to invest, that matters.

The real test, however, will not be whether the strategy is well written, but whether successive governments (including the new one about to start work) have the discipline to stick to it.

What could skills policy look like under a Burnham-led government?

The prospect of Andy Burnham succeeding Keir Starmer as Prime Minister is significant for the skills sector. Burnham is a strong advocate for technical education and has criticised previous governments for their ‘obsession’ with higher education, including former Labour Prime Minister Tony Blair’s target of having more than 50% of young people go to university.

In his first major speech since launching his bid to replace Starmer on Monday 29 June, Burnham acknowledged that while university is ‘great for those who want it’, there also needs to be a focus on the life chances of those who don’t wish to opt for the higher education route. Given he has long called for ‘true parity’ between academic and technical education, as highlighted in his manifesto for his 2015 Labour leadership bid, Burnham is likely to place much greater emphasis on study programmes linked to in-demand technical and vocational occupations as part of a broader effort to create clearer pathways into employment for young people.

Burham’s Manchester Baccalaureate (MBacc), which provides a pathway into the region’s high growth sectors through technical and vocational qualifications, is a clear example of what this shift could look like on a national scale. Launched by the Greater Manchester Combined Authority (GMCA) in September 2024, the MBacc guarantees every young person in the region a clear pathway to employment opportunities through a combination of careers advice services, work experience placements and technical qualifications, including by expanding access to T Levels and apprenticeships.

Since its launch in 2024-25, the MBacc has benefitted from growing support amongst local employers. In January 2026, GMCA confirmed that several leading employers, including Autotrader, IBM and the NHS, had pledged over 1,000 additional work placements to T Level students. This demonstrates how engaged and invested businesses can be in skills and the future workforce, provided the right policy framework is in place. The MBacc not only provides technical education routes into growing regional industries, but it also encourages young people to make subject choices at the ages of 14, 16 and 18 that support progression into these pathways.

Another aspect of Burnham’s approach is the emphasis he places on greater collaboration between skills, health and employment, specifically the need to adopt a place-based model while pivoting away from a nationally directed skills system. One of the advantages of a place-based model is the recognition of significant regional differences in the causes of unemployment and the nature of local labour markets. This includes inconsistent access to training provision and the variety of opportunities for growth across the country. A Burnham-led government is likely therefore to see more devolution by default, whereby employment support is further integrated with local health, skills and community services. This would mean that providers in the FE and HE sectors play a much larger role in supporting people into work.

A Burnham premiership is likely to see a more devolved and technically-focused skills and training system. On a practical level, this is likely to involve granting established combined mayoral authorities (like London, Greater Manchester and the West Midlands) greater autonomy in shaping skills provision around local labour market demands. For employers and training providers, this direction of travel will place greater emphasis on more joined-up local working and support across education, health and employment services. While this has the potential to significantly transform the skills sector, the test for Burnham is whether he can demonstrate that a localised, devolved approach will deliver economic growth, boost living standards, and give every young person growing up a ‘clear path into a re-industrialised Britain’.

If you would like to talk more the potential of a Burnham-led government and what this could mean for the skills sector, please email Noureen@gkstrategy.com.

EU Youth Mobility Scheme: Brexit divisions and the Burnham factor

GK’s Brett Morton examines the ongoing negotiations with the EU on a youth mobility scheme and what it means for the future of the UK-EU relationship

A youth mobility agreement has become a central component of the Labour government’s drive to improve UK-EU relations. Although both sides broadly support the principle of making it easier for young people to live, work and study across borders, the parties remain divided over the terms. Points of contention over immigration caps and tuition fees risk preventing a wider package of UK-EU cooperation measures. Both sides had been keen to secure these at a second bilateral summit scheduled for 22 July in Brussels. The summit has now been delayed following the Prime Minister’s resignation.

The scheme under discussion would allow 18-30-year-olds from the UK and EU to spend a limited period living, studying and working in each other’s countries. In broad terms, it would resemble the agreement the UK already has with countries such as Australia and Canada. Under those arrangements, young people can come to Britain for up to three years, subject to visa rules and annual caps, and work, travel or study without employer sponsorship. The UK would like any deal with the EU to follow the same basic model: temporary, managed and clearly distinct from free movement.

That distinction matters because immigration remains one of the most politically charged legacies of Brexit. Opponents of the proposal, including Nigel Farage, argue that such a scheme would amount to freedom of movement under a different name. Ministers have been keen to stress that any agreement with the EU would be time-limited and capped. Reports suggest the Starmer government favoured a ceiling of 50,000 participants a year. The EU, by contrast, is believed to prefer a more flexible arrangement, with no fixed cap but a break mechanism that would allow either side to intervene if numbers became excessive. For the next Prime Minister, accepting a scheme without a visible numerical limit would be politically difficult, particularly given the public’s appetite to reduce net migration.

Since Brexit, labour shortages have become a persistent problem in sectors such as hospitality, agriculture and construction. At present, a young EU citizen who wants to work in the UK for a limited period usually needs sponsorship from a British employer. In practice, that system is often costly, bureaucratic and tied to salary thresholds that many small businesses cannot meet. In many cases, sponsorship requires employers to offer a salary of at least £41,700 a year, or the going rate for the role, which places it out of reach for much seasonal, temporary and lower-paid work. Supporters of a youth mobility scheme argue that without the need for sponsorship or salary thresholds, it could widen the pool of labour and make it easier to fill temporary or seasonal vacancies. Even so, its impact would be limited, as it may ease pressure in high-turnover sectors but would do far less to address longer-term shortages in fields that depend on permanent skilled workers, such as healthcare or technology.

A major obstacle to a youth mobility agreement is tuition fees. The EU wants students to study in the UK and EU countries on the same basis as domestic students, meaning EU students at UK universities would pay home fees rather than higher international rates. With 24 institutions reportedly at risk of insolvency within the next year, according to the Education Select Committee, international student fees have become a vital source of income. The Russel Group, an association of 24 prestigious universities in the UK, has warned that granting EU students home fee status could cost the sector around £580 million, reducing universities’ ability to invest in programmes such as Erasmus+ and Horizon Europe.

The youth mobility debate must also be understood in its wider political context. Starmer had originally hoped that a UK-EU reset would help revive his premiership by showing that closer cooperation with Europe could deliver practical benefits, from smoother trade to lower costs for consumers. With his resignation, that personal political purpose has fallen away. Future negotiations are no longer about rescuing his administration, but about shaping the direction of the next Prime Minister’s agenda.

With an Andy Burnham coronation now increasingly likely ahead of 22 July, the EU has postponed the summit. A youth mobility scheme could offer Burnham an opportunity to pursue economic and social reforms in response to what he has described as the ‘damage’ caused by Brexit. However, Burnham is also likely to be cautious about making significant concessions to Brussels, particularly on a cap, as he seeks to appeal to Reform UK voters and avoid reopening divisions from the Brexit referendum ahead of a potential 2029 general election. The future of any youth mobility scheme with the EU will therefore depend on Burnham’s political calculus.

View from the US: Wealth taxes and universal income

Erin Caddell of GK Strategy’s American partner Anchor Advisors unpacks the prospect of wealth taxes on ultra-high net worth individuals and universal basic income to address heightened scrutiny of wealth inequality in the US

Stunning rise in tech wealth reignites policy debate about U.S. income inequality

The dramatic increase in market capitalization among US-based AI and other tech-related companies in recent years, encapsulated by last week’s whopper IPO for SpaceX, is reinvigorating a long-running debate about income inequality in America. Proposals for redistributive policies, such as wealth taxes and universal basic income (UBI), are gaining a new currency in US state capitals and in Washington DC.

The wealth creation of the AI boom is staggering. The SpaceX IPO made founder Elon Musk the world’s first trillionaire. Following Musk, the next nine richest Americans have a collective net worth of $1.7 trillion according to Forbes. All but one of whom (Warren Buffett) is a tech co-founder. Americans for Tax Fairness, a tax advocacy group, estimated that the net worth of America’s roughly 1,000 billionaires has increased by $1.5 trillion in 2025 to $8.2 trillion. Much of the rise is being driven by AI’s boost to tech content and infrastructure providers (as well as the tax cuts approved by President Trump and the GOP-controlled Congress last year).

The achievements of the ultra-rich in harnessing the promise of the latest technology revolution have drawn the ire of everyday Americans grappling with high inflation, increased healthcare costs and the threat of jobs being displaced by AI. This shift in public sentiment is turning on its head an old adage that Americans do not support higher taxes on the wealthy because many believe they, too, will become rich one day in the land of opportunity. A YouGov poll released in January found that 59% of Americans surveyed agreed that the government should pursue policies that narrow the gap between the rich and poor, with a majority of those Republicans surveyed agreeing that the wealth gap is a big problem. Compare this to 1939, when a Fortune magazine poll found only 35% of Americans surveyed felt wealth should be redistributed through higher taxes on the rich.

Policymakers looking for support to address income inequality can point to evidence that the gap between rich and poor is even wider now than in the Gilded Age of the late 19th century when the technologies of the Industrial Revolution created the first cohort of the ultra-wealthy in America; and ultimately a backlash that led to the antitrust actions around the turn of the century, and later to establishment of the federal income tax in 1916.

Gabriel Zucman, a leading international scholar of wealth inequality, published a book in May with the wonderfully direct title ‘We Need to Tax Billionaires’. It found that the wealth of the top 0.0001% of the world’s richest families represented more than 16% of world GDP in 2025, up from 4% in 1910, and 3% in the mid-1980s.

The early skirmishes on the income-inequality debate are playing out in the American states, where public sentiment can be codified into policy more quickly than at the federal level. Earlier this year, the legislation in Washington state (home of Microsoft and Amazon) was passed and its governor signed a new 9.9% state tax on annual incomes above US$1 million. Massachusetts has levied a 4% surcharge on $1 million-plus earners since 2022. Colorado, Connecticut, Hawaii, Michigan, New York and Rhode Island are considering similar measures.

California, the epicenter of both the AI revolution and worries about thousands of jobs being made obsolete by it, recently submitted enough signatures to place a ‘billionaires’ tax’ on the November 2026 ballot. The measure would impose a one-time 5% tax on California residents with net worth of greater than $1bn, a move projected to raise US$100 billion to fund healthcare, education and food assistance. The initiative has already roiled the state and potentially national politics. California Governor, and likely 2028 Democratic presidential candidate Gavin Newsom, has opposed the measure, arguing it would hurt the state’s tech industry. Labor unions that initiated the proposal are considering a compromise to lower the proposed tax to 2%.

Universal basic income (UBI) is the flip side of the wealth tax. Dating back centuries, UBI intends to provide a modest but unconditional income to all citizens of a society to recognize the dignity and value of each person and to share the benefits of a nation’s bounty. The idea has gained new currency amidst renewed concern in recent years about displacement of workers by technology. Twitter founder Jack Dorsey gave $15 million to a group called the Mayors for a Guaranteed Income to divide into a series of UBI pilot programs. UBI pilots have been launched in recent years in cities including Stockton, California; Durham, North Carolina; and Baltimore, Maryland.

With Trump and the GOP focused on lowering taxes rather than raising them, wealth levies and UBI programs are non-starters at the federal level now. This could change. Democrats are making income inequality a key plank in their campaign for the November midterm elections. Should Democrats win back the White House and gain control of both houses of Congress in 2028 (as Biden and his party did in 2020), they would likely consider wealth-tax proposals already circulating among party leaders. The ‘Billionaires’ Income Tax’ bill proposed in September 2025, for instance, would subject individual taxpayers with assets of greater than US$1 billion or annual income of more than $100 million a year for three consecutive years to an annual tax based on the net gain of their assets (or to deduct the losses). The bill was proposed in the Senate by Finance Committee Ranking Member Ron Wyden (D-OR), a leading voice in Democratic tax policy, and co-sponsored by 20 Democratic Senators.

While UBI has less support at the federal level than wealth taxes, UBI could also gain favor in a Democrat-controlled White House, Senate and House. In October 2025, a dozen Democratic House members led by Rep. Bonnie Watson Coleman (D-NJ) introduced the Guaranteed Income Pilot Program Act, which would provide income equivalent to rent for a two-bedroom apartment for an initial test group of 20,000 Americans. Even Musk himself has become a proponent of UBI, posting on X in April that ‘Universal HIGH INCOME via checks issued by the Federal government is the best way to deal with unemployment caused by AI’.

Individual federal income-tax rates have declined in the US from 91% in 1955 (a vestige of increases to help pay for World War II) to 37% in 2025, while capital-gains taxes have held around 25% over the past decade, according to the Peterson Foundation (see below). Not coincidentally, the entrepreneur has risen in the eyes of the American public during this period, as the ’Organization Man’ archetype of the loyal cog in the paternalistic corporation gave way to the us-against-the-world mindset of the U.S. tech industry, best symbolized by the foundings of Apple and Microsoft in the mid-1970s.

Through the commercialization of the internet in the mid-1990s, to the rise of social media 20 years later, to the acceleration of generative AI with the launch of ChatGPT in 2022, technology has become ever-more central to the U.S. economy and society. Yet the widening gap between the few at the top and the rest below seems to have driven a policy tipping point. With the federal deficit at 6% of GDP, the highest in U.S. history outside of war and the covid-19 pandemic, and individual tax receipts the largest source of federal revenue at 50%, it seems a question of when, not if U.S. policymakers will have to consider raising taxes. The ultra-wealthy are an easy target as part of such an effort. At the same time, pressure to distribute more of the benefits of the tech boom to the rank-and-file who bear its brunt also seems poised to continue to rise through increased support for UBI, as well as for higher standard deductions for federal income taxes, as multiple progressive policymakers have proposed recently.

What does this mean for US-focused investors and corporates?

We do not profess to be able to predict when or by how much tax rates on wealthy Americans will rise. But we do see several downstream effects impacting US-centric companies and their owners from the increased focus on income inequality.

First, a redistributive shift in the tax system would be positive for firms that help individuals and small businesses prepare their income taxes (yes, including those who assist wealthy people in looking for ways to pay less in tax), as well as the many companies that provide services to the tax-preparation industry itself.

Second, companies and investors should be more prepared to view their actions in the U.S. through a more populist lens and to delineate the benefits of their products and services beyond the limited traditional corporate stakeholders of shareholders, customers and employees. Take data centers. In recent years, the tech firms developing the data centers powering the AI boom, led by the multi-billionaires highlighted above, believed the substantial tax revenue they planned to bring to mostly rural or suburban communities where data centers are located would be enough to win support from local citizens. With many local governments across the political spectrum working to halt data-center construction due to concerns about resource utilization and quality of life, developers must take a more holistic approach, thinking through ways to offset the centers’ electricity and water usage; expanding efforts to reduce noise and other potential environmental impacts; and partnering with impacted communities to share in the benefits of the center’s economic activity beyond just paying a tax bill.

Third, should UBI proposals gain further support at the state or federal level, it would help providers of affordable housing, an industry already under the spotlight at the federal and state level as many regions of the U.S. deal with housing affordability issues and shortages.

Whatever the outcome of these and similar debates, income inequality and policies to address it are sure to occupy a larger place in the U.S. policy landscape in years to come.

 

NHS Recovery and Productivity: Diagnostics are the place to start

Drawing on his experience as a Health Minister and Chair of the Health and Social Care Select Committee, GK’s strategic advisor Steve Brine argues that diagnostics are the critical but often overlooked foundation of NHS recovery, productivity and prevention.

Diagnostics rarely grab headlines in the way that waiting lists do. Yet during my time as a Health Minister, and later as Chair of the Health and Social Care Select Committee, I came to a simple conclusion – if you want to improve outcomes, reduce elective waits and modernise the NHS, they are the place to start.

The reality is that no patient can begin the right treatment until the clinicians know what is wrong. Whether it is cancer, heart disease or a musculoskeletal problem, diagnosis is the gateway through which every effective pathway runs.

Too often, however, diagnostics are viewed as a ‘supporting service’ rather than the critical infrastructure on which the entire system rests.

That is why I have been encouraged by the development of Community Diagnostic Centres (CDC’s) under the last government and continued under this administration.

The concept is straightforward but powerful; bring scans, tests and investigations closer to where people live, rather than requiring patients to navigate busy acute hospitals. It is one of the clearest examples of the much-discussed shift from hospital to community becoming more than words on a page and something that patients can see.

When I was a Minister, we spoke frequently about prevention and early intervention. Now it’s the talk of the town.

For my money, diagnostics sit at the heart of both. A CT scan, MRI scan or PET scan (Positron Emission Tomography, which is particularly important in cancer diagnosis and treatment planning) is not simply a test. It is an opportunity to identify disease earlier, provide reassurance quicker, and avoid patients deteriorating while waiting for answers.

As Select Committee Chair, I often heard evidence about the pressures facing the NHS workforce and the challenge of delivering constitutional standards. The current debate about the 18-week elective target is important, but it is worth remembering that elective recovery ultimately depends on diagnostic recovery. You cannot clear waiting lists if patients are waiting months for scans, endoscopy or reporting.

That is why diagnostics should be seen as a productivity issue as much as a clinical one. Faster access to tests means quicker clinical decisions, more efficient use of outpatient appointments and better use of operating theatres. Every delayed diagnosis creates friction elsewhere in the system and, most important of all, spikes anxiety in patients. The dreaded diagnosis ‘odyssey’.

The challenge now is ensuring that CDC’s become a permanent part of NHS infrastructure rather than simply a waiting-list initiative. That means investing not only in buildings and scanners, but also in the workforce; radiographers, radiologists etc.

If ministers are serious about restoring performance (which as we will explore further in this series of blogs I am writing for GK Strategy is only part of the story), improving cancer outcomes and delivering care closer to home, it’s hard to look past diagnostics as the place where the next chapter of NHS reform must begin.