The Week 21 March 2025
Senior Researcher
Last week, the PM promised to take on quangos and announced that NHS England, the “world’s biggest”, would be abolished. This came two weeks after Re:State called on government to take more control over public bodies and less than a year after we argued for the abolition of NHS England.
This week, the Government published a much-trailed green paper on welfare reform, promising a new approach to disability benefits and support — itself largely drawing on arguments and recommendations made in our 2016 paper ‘Working Welfare’. Our Director Charlotte Pickles explained what that meant in her blog here.
As if Whitehall-watchers weren’t busy enough digesting those announcements and going through Re:State’s back catalogue for the detail, next week we’ll have the OBR’s March outlook on the public finances — a key test for government, which is expected to find that the Chancellor’s headroom (money left against her fiscal targets) has been wiped out due to disappointing growth numbers and higher borrowing, triggering announcements on spending and (less likely on) tax.
Cue stories of departments facing budget cuts of “up to 11%” and Treasury officials scrambling to identify savings from already-stretched settlements while minimising disruption to frontline services. Just as announcements over the last two weeks had implications for spending but also prompted a more fundamental rethink of how services work, Darren Jones, Chief Secretary to the Treasury, is right to see this as an opportunity for the Treasury to change how it targets efficiency.
In a speech yesterday, he set out an approach based on a “single version of the truth” that would give the Treasury greater access to real-time performance and finance info rather than having to wait on individual submissions from departments. In return, departments will be offered more autonomy for spending and, optimistically, less Treasury micromanagement.
This is a positive direction of travel; Re:State has long argued that targeting efficiency day-to-day relies on more detailed, comprehensive and real-time finance information to guide spending choices. Instead, officials have told us that monitoring spending too often means “filling in spreadsheets and passing them up the chain of command”. And of course, it is more effective to realise savings on a continuous basis — by rewarding officials for securing value for money — than it is to frantically and tactically make cuts in the run-up to a budget or economic outlook.
The OBR’s outlook will also set the scene for an even more important Spending Review later this year, in which the government’s collective strategy for delivering its missions and public services will come into clear focus. Here’s hoping the Chancellor’s approach will be a reform-minded one.
Onto the read of the week
Our read this week is an analysis from our friends at the IFS on whether the Government will be able to achieve its priority NHS target, for 92% of patients to wait no longer than 18 weeks for elective hospital care. Interestingly, it suggests that there is an unclear relationship between the total size of waiting lists and average waiting times. For example, in July 2017, 18-week performance was 90% and in September 2007, it was only 59%, in both cases with a total waiting list of 4 million patients.
It also finds that plausible increases in the rate at which patients are treated will still leave the health service a long way off meeting the 18-week target by the end of the Parliament, a commitment set out last year. Treatment volumes would need to increase by 4.9% a year to meet the target by 2029 — more than double the average growth rate of the 2010s. Required reading for DHSC as it looks to implement its elective recovery plan.