The Health and Care Bill is the most significant piece of health legislation this parliament, and will shape the structures of the NHS, how services are delivered, and improvements to population health over the next decade.

Organisations not planning ahead for these changes, may find themselves unable to cut through to the necessary decision-makers in local regions to ensure they can continue to deliver services to institutions and patients.

To read more about how GK Strategy can advise and support you with these changes you can find more here in our analysis on the Health & Care Bill

For any questions or to discuss the health & care political and policy landscape contact joecormack@gkstrategy.com

After a dramatic week in politics that nobody would have predicted, Matt Hancock, who had served as Secretary of State for Health and Social Care for almost three years was ousted from the department at the weekend. Replaced by Sajid Javid who was parachuted back into Boris Johnson’s cabinet on Saturday 26 June. However, with the world of healthcare policy moving at pace, Javid will have little time to get his feet under the table and set his priorities. In many ways, these priorities will be determined for him not by him, due to the circumstances of the healthcare landscape that he inherits. Below, we’ve outlined five key priorities that Javid will have no choice but to grasp in the weeks and months that come, and in some cases, in the next few days.

The pandemic and success of the vaccination programme

While issues and decisions swirl at the upper echelons healthcare policy, one undisputed political success for this government is the COVID-19 vaccination programme. An astonishing number of people have been vaccinated in the UK, with one jab or two, and this has cut hospitalisations and deaths to far more manageable levels than during any other time in the pandemic. That said, the battle is not over. Booster jabs in the Autumn and management of the pandemic through the Winter and Spring will be paramount to keeping this government stable. Any derailing of this programme could have serious consequences for this government. And Javid is the new face of COVID-19 vaccinations, whether he likes it or not.

The Health and Social Care Bill

The Bill – first expected to be published this week, but now delayed (for how long is still unknown) – ushers in a major reshuffle of the planning and management of health and care in this country. This is no small task during a major pandemic and personnel changes at the top (in NHS England as well as in government) only serves to raise more questions about the process we all thought would be relatively straightforward. Any delay to the publication of the Bill may mean implementation will be tricky. ICSs are due to become statutory by April 2022, but will that be feasible if the legislation is continually delayed? If we look to April 2023, what impact could that have on an upcoming general election?

Javid will need time to get to grips with the Bill, and without any political or operational sponsors (with Hancock and Simon Stevens out of the equation, and reported concerns in No 10), there is now the possibility that the Bill changes in any number of ways.

The NHS backlog

One of the major – and very real – issues facing the health system is the huge backlog of diagnoses and treatments that continues to expand at an alarming rate, most acutely as a result of the pandemic. Some reports suggest waiting lists are increasing by 50,000 a week and it will not be long before this becomes a major political and public issue. The Bill, the pandemic, and the wider reforms and funding landscape will all have a dramatic impact on meeting this challenge and Javid will want to act fast to prevent it becoming uncontrollable.

Simon Stevens’ departure and appointing a new Chief Executive of NHS England

Change at the top – during some of the biggest health challenges facing our country in decades – always brings uncertainty and instability. That a Secretary of State can depart during the same period that a Chief Executive of NHS England departs will be an acute challenge. Some of the names touted for the top job – the likes of Dido Harding – could bring significant scrutiny to Javid and No 10. Undoubtedly. Javid and Boris Johnson will look to appoint someone operational, someone politically uncontroversial – indeed, mostly unknown – and someone who can be close to the centre as it looks to consolidate power. This appointment is no small decision and has the potential to affect all the other priorities on Javid’s list, so getting it right will be crucial for him.

Social care

Social care has been the perennial problem for governments for many years now. Nobody wants to tackle it because there is little political benefit in doing so. It’s complicated, expensive and the incentives are unfavourable. Sajid Javid may bring his knowledge of the Treasury and friendship with Rishi Sunak to this problem to find a real solution that delivers for the country. More likely, however, is a stopgap solution that kicks the can further down the road – such as a cap. It will not solve the problem, will not improve services, but could deliver (in a roundabout way) the Government’s commitment to act. Javid will have to act quickly if he is going to act at all, as the Spending Review will come around quickly, and the negotiations (with potential trade-offs) will be long.

These are just a handful of issues that the government faces. There are many more – from public health reform to workforce challenges – the in-tray in Javid’s office will be overflowing. If you would be interested in hearing more on any of these issues, or indeed believe other priorities should make their way onto this list, do get in touch with ian@gkstrategy.com and we can setup a call to discuss further.

GK Strategy hosted a policy insights event on the future of mental health in the UK, hosted by former Care Minister and GK Adviser, Phil Hope, with Sir Norman Lamb, Chair of the South London and Maudsley NHS Foundation Trust and former Health Minister during the Coalition Government. 

In a watershed year for mental health policy, the discussion was wide-ranging and covered everything from the review of the Mental Health Act to the spending power of local authorities. Key issues to note from the discussion include:

1. There is not yet parity of esteem between mental health and physical health services

While funding commitments in mental health have increased in recent years, it still does not receive the ‘parity of esteem’ that so many have been calling for and that the Government hopes to achieve.

Sir Norman Lamb was quick to highlight that waiting lists are still ‘shockingly high’, particularly for young people who can sometimes see waits of a year before receiving treatment. Moreover, facilities need upgrading and there are still systemic barriers to the way mental health is perceived which prevent reaching parity. The review of the Mental Health Act is one area this could be addressed, as current proposals are a step in the right direction.

2. Workforce and skills shortages in mental health may prevent progress

Phil Hope highlighted that workforce and skills is ‘still a massive issue’, and Sir Norman Lamb recognised that quality recruitment in the independent and third sectors can be very difficult. Reform to the immigration points system was recognised as a route to improving international recruitment.

The need for investment in training was also highlighted as a necessity for upskilling staff. Recent investment announced by the government for training and expanding mental health teams in schools, to support children and young people, was welcomed.

3. The shift from competition to collaboration poses both a threat and an opportunity

Due to the UK’s departure from the European Union, European procurement rules no longer apply to the UK. These rules required a robust, competitive process but the UK’s departure aligns with a move to collaboration rather than competition. Sir Norman Lamb expressed some concern that this lack of competitive process may lead to reduction in quality, as providers become less driven by the standards of their competitors. Both Sir Norman Lamb and Phil Hope agreed therefore that there needed to be other means of holding the system accountable.

Sir Norman Lamb highlighted the importance of provider collaboratives, as well as the new statutory setup of Integrated Care Systems (ICSs). Both speakers shared concerns that local boards held no decision-making powers and became simply ‘talking shops’. Sir Norman Lamb expressed his concern that the proposals for ICSs did not require the presence of a mental health voice at the table – this was optional as per the decisions of each board.

4. The importance of capital investment and Treasury requirements

Both Phil Hope and Sir Norman Lamb recognised a ‘huge need’ for capital investment in learning disability and mental health facilities. Sir Norman Lamb stated that the quality of some facilities ‘is currently unconscionable’. There was recognition that capital funding limits (known as CDEL) imposed by the Treasury have led to massive constraints in this area.

It was suggested that this may open the door for public-private partnerships, because the private sector can make the investments for capital. It was suggested that controls in the NHS White Paper on capital expenditure decisions would be ‘a retrograde step’.

5. The case for social care reform continues to mount

It was noted that reform of social care has been a talking point for a long time, but whether it will come soon neither Sir Norman Lamb nor Phil Hope could predict. Sir Norman Lamb recognised that the UK does not ‘spend enough as a society’ on social care, and that the ‘consequences are there for all to see’. Sir Norman Lamb said that he personally prefers a social insurance model for social care funding that protects younger working adults. The role of local authorities in mental health care was also discussed, and Sir Norman Lamb highlighted that new funding for mental health services cannot simply recategorize funding from other budgets, such as those for local authorities.

A recording of the event is available to view if you were unable to join us or would like to revisit

To discuss these issues further or if you have any questions related to mental health and social care policy, please do get in touch via ian@gkstrategy.com and we would be delighted to setup a call with you.