The Waiting Room with Atticus Partners

Welcome to the first edition of the Atticus Partners Health Newsletter: The Waiting Room. The first in a regular series, these bulletins will aim to bring you updates on what Atticus is doing within the health space, including blogs, insights, and our #AskAtticus speaker series, as well as key news and political updates of relevance to the sector.?

In this edition, we analyse what recent political developments such as the Autumn Statement mean for the sector, as well as developments around NHS waiting times and the ongoing COVID-19 inquiry.??

For more information about Atticus’s work in the health sector, or if you have any questions about how we can support you, please get in touch via [email protected].?

The Autumn Statement: A Potentially Unhealthy Moment for the Sector...

The Chancellor Jeremy Hunt delivered his Autumn Statement on the 22nd November, with the aim of highlighting the success of the Government’s plan to put the economy “back on track” after a challenging year. There were relatively few announcements related to health directly, with the Chancellor’s focus remaining on emphasising the Government’s story of economic progress.??

The headlines from the Autumn Statement were a 2p cut in employee National Insurance Contributions (NICs) worth ￡9 billion and ￡11 billion spent on making ‘full expensing’ permanent, which the Government framed as providing crucial support to workers and a significant boost to business investment. While these tax cuts were welcomed by many, particularly those on the right of the Conservative Party, the Office for Budget Responsibility (OBR) forecast shows that the tax burden will still reach a post-war high of 37.7% by 2028/29, largely due to fiscal drag caused by frozen tax thresholds. The OBR predicts that the effects of inflation will lead to a “￡19.1bn erosion in the real value of departmental spending” by 2027-28 compared to March forecasts.?

However, almost all political commentators believe that the spending plans – most of which are pencilled in for after the next general election – are unrealistic. Paul Johnson, Director of the Institute for Fiscal Studies (IFS), warned that they are “implausibly tight”. If the?spending plans do end up materialising, even if partially scaled back, they will have a significant impact on already struggling public services. The IFS found that while in 2021, the planned increase would have seen the NHS benefit from average real funding growth of 3.0%, this will now fall to 2.1%. However, given the political salience of the health service and the funding that would be required to deliver the government’s historic NHS long-term workforce plan, its future outlook may be relatively positive compared to other unprotected areas of spending.??

Despite this real funding growth, some medics recently warned that NHS waiting lists could hit 9 million patients in the next two years. The recent news that a fresh pay offer to NHS consultants could end industrial action in England would be a step in the right direction in tackling the NHS backlog, although no deal has yet been reached.?

The reduction in NICs is a notable development and reflects the degree of policy volatility in recent years. Just over two years ago, with waiting lists at 6 million, the then Chancellor Rishi Sunak announced a rise in NICs to 13.25% which was described as “necessary, fair and responsible” and a means to support the NHS and social care after the pandemic. However, two years later, with waiting lists at a record 7.8 million, NICs have been significantly cut.??

While the tax cuts in the Autumn Statement will be welcomed by many who are struggling with the cost-of-living, recent polling found that 52% of people said they support raising taxes to increase spending on health inequalities. Therefore, while largely absent from this Autumn Statement, the health service and debates around its future funding will likely be a salient political issue at the upcoming general election as has historically been the case.

Covid 19 Hits the Headlines - Again

COVID-19 has made yet another appearance across headlines. This time, the COVID-19 inquiry is examining the Government's handling of the pandemic. The inquiry was set up "to examine the UK's response to and impact of the COVID-19 pandemic and learn lessons for the future". The second module, currently ongoing until 14th December, focuses on core UK decision-making and political governance.?

Reactions to the inquiry have been varied. Those on the right have largely been focused on the inquiry itself, highlighting that it isn’t asking the key question: did the benefits outweigh the cost? Those who have focused on lockdown timings include Dame Angela McLean, the Government's Deputy Chief Scientific Adviser during the pandemic, who stated in the inquiry that former Prime Minister Boris Johnson could have helped the UK avoid an increase in deaths if he had taken the advice to announce a “circuit-breaker” lockdown, which he did weeks later.???

Most recently, Michael Gove has also contributed to the inquiry, claiming that the Government didn’t “lock down early enough” and they “didn’t go hard enough” on lockdowns. He cautioned against making similar mistakes in the future - but defended then Prime Minister, Boris Johnson, maintaining that “we all deserve our share retrospectively of criticism”.?

With a week focusing on a single “module” in the inquiry’s programme devoted to “core UK decision-making and political governance”, part of the answer is that the critics could be more patient. Four more modules on a range of topics still to be considered, including preparedness, impact on healthcare, vaccines, procurement and the care sector. One thing to bear in mind is that whilst some critics have made up their minds, the inquiry has not.

A Waiting Game

Of the five pledges which have served as his political lodestar in 2023, Rishi Sunak is struggling most with the seemingly intractable issue of cutting overall NHS waiting lists, although the longest waits are falling. With the backlog currently at a record high, and analysis by the Health Foundation finding that industrial action in the health service has continued to exacerbate the problem, it is expected that the waiting list for ‘elective care’ in England could reach 8 million by next summer. The health service is also experiencing severe difficulties across the devolved nations. Recent figures revealed that NHS waiting times have hit another record high for those waiting for hospital treatment in Wales, which is particularly concerning development ahead of the traditionally busy winter period.

The Labour Party has used the health service as a key attack line against the Government, despite only delivering limited pledges for the health service itself. This has largely centred around abolishing the non-dom status to fund additional investment in the NHS.??

However, health experts have frequently argued that spending will have to rise by between 3-4% in real terms over the coming decade, alongside consistently abandoned reforms such as those to social care, to keep up with rising demand and an ageing population.??

This suggests that waiting lists are likely to remain at historically high levels based on current pledges. With YouGov polling putting the NHS as the second most important issue for voters behind only the economy, the health service will remain a politically fraught issue - regardless of which party forms the next government - for the foreseeable future.?

A Cheat Code? Maybe not

In the last year, we’ve seen social media revel at what many have called the ‘wonder drug’, with it sold across Hollywood. Otherwise known as Ozempic, or by its off-brand name, Semaglutide, the drug emerged as a type 2 diabetes medication - intended to lower blood-sugar levels and slow down food leaving the stomach.??

It has since been used as a weight loss drug, with medical professionals administrating it to those with a BMI of over 35. Reaching the shores of the UK soon after its rise in popularity in the US, many companies have sought to replicate the drug and sell it as an off-label medication. The direct result of this was a significant shortage of the medication globally, meaning the UK was having to ration the product.?

Alongside the depletion of supplies came a new and far more dangerous product - companies attempting to sell similar products, but without the regulation or science behind it. This has had a direct impact on consumers, with many needing hospitalisation as a result of consumption.??

The Medicines and Healthcare Products Regulatory Agency (MHRA) says it has received reports of people ending up in hospital after using fake Ozempic pens. This has resulted in over 300 seizures since the beginning of the year - with many health professionals believing there are similar products circulating in the market that regulatory bodies are not aware of.?

Understanding the risks, the MHRA has said it will look to use its powers to ‘protect the public’, taking ‘appropriate enforcement’ where needed. Within the last 6 weeks, the organisation has already identified two wholesalers who have been selling Semaglutide illegally.?

As the illicit market continues to grow, it remains to be seen how health authorities, regulators and policymakers will respond.??

Insights from Atticus Partners

Our most recent insights across the health space include:?

• World Diabetes Day 2023: Exploring diabetes technology and healthcare disparities in the UK?
• A little bit of T.L.C this Breast Cancer Awareness Month?

To find out more about how Atticus helps health organisations navigate the changing regulatory and legislative landscape, get in touch with our team at [email protected] to learn more about what we can do for you.?