The Week, 11 November 2022

Another week, another set of record-breakingly bad NHS numbers.

The most shocking data comes from A&E. According to the NHS’s own targets, 95 per cent of patients should be admitted, transferred or discharged within four hours of arriving at A&E. The actual number in October was 55 per cent. Before the pandemic, it was virtually unheard of for patients to wait more than 12 hours after a decision to admit them to a ward. Last month, more than 40,000 patients were in that position.

The cause of these huge delays is not straightforward. The number of people attending A&E has not increased since October 2019, so the problem is unlikely to do with increased demand. That leaves two culprits — failures to manage the flow of patients through hospital wards and problems with discharging patients at the other end.

Patient flow has long been a problem in the NHS and we clearly need to better manage bed space so capacity can be freed as quickly as possible. A failure to discharge would likely be down to the crisis in social care — if care can’t be found outside of hospital, older, frail patients (who dominate wards) remain stuck in beds. Unfortunately, the NHS has not published data on Delayed Transfers of Care since the start of the pandemic, and it’s not clear why.

Speaking of social care, this week saw the Prime Minister delay Boris Johnson’s flagship commitment to put a cap on care costs. At Reform we were never huge fans of the cap (see why here) — of all the problems facing the adult social care sector, protecting the assets of wealthy pensioners is not the most pressing. Nevertheless, it is a worrying sign that desperately needed social care reform may (yet again) be kicked down the road. That would be a let down to the 2 million adults in England who draw on social care, and (see above) make the NHS’ challenges even more difficult to solve. And if the past few years have shown us anything, it is surely that the absence of long-term policy and investment makes Britain far more vulnerable to crises.

In non health and care news this week, today the NAO published a report on cross-government support for vulnerable adolescents. This is a crucial and often over-looked area of policy — supporting vulnerable young people is vital for transforming lives and avoiding large, long-term costs to the taxpayer. The report’s most important finding is that joining-up policy and understanding what works in this area is being made more difficult by failings in data collection and sharing. This means that “central government has a limited knowledge of whether the same adolescents are known to or receiving support from different local services”. An urgent area for reform.

On to some weekend reads…

First up is this paper launching the Institute for Employment Studies' new commission on the Future of Employment Support. It’s a great, high-level summary of where we’re at when it comes to labour market policy and outcomes. The paper points out that the UK is unique among advanced economies in a number of important (and negative) ways — we are the only country which has seen employment fall over the last two and a half years, and we perform particularly badly when it comes to income inequality and poverty rates. We can and should do better. We're intrigued to see that, among a lot of familiar labour market names, the actor Michael Sheen is a member of the commission. We'll be interested in the ideas produced by this group.

Second, this report from the Fabian Society considers the lessons the UK can learn from Germany’s (relatively) successful approach to closing regional inequalities. The lessons include the importance of long-term investment at scale and the need to focus on the economies of a diverse range of places (not just cities). No surprises there. But the report’s main finding is the success of Germany’s economic policy is the product of combining devolution with effective collaboration between different tiers of government. One to read as debates on Levelling Up rumble on…