The Week 28 February 2025
Policy Director
Blimey. The news cycle isn’t slowing down this year, is it? That’s just as true in the domestic policy world, where in the space of a week we’ve had the start of regime change in NHS England, the launch of the new procurement system, a new deal – and a boost in funding – for GPs, much more flexibility for sweeping local government reorganisation, an NAO report explaining exactly how unsustainable local government finances are (in case we didn’t already know)… oh, and the publication of a landmark new paper on how to manage the UK’s rapid march toward becoming a ‘Quangocracy’, courtesy of Reform’s own Patrick King and Alice Semark.
The new settlement announced with GPs this morning reflects the reality that Primary Care has for a long time been treated as a poor relation in the NHS. Lack of capacity in this part of the system just means more emergency admissions, and more demand overwhelming the hospitals that then absorb the lion’s share of resources.
It’s good, then, to see the beginning of a rebalancing of priorities within the health system, alongside some sensible reforms (fewer centrally mandated targets, less bureaucracy overall, and a doubling-down on online appointment booking).
Whether the cash injection constitutes enough of a boost – it’s less than 5% of the overall NHS budget increase announced at the last budget – remains to be seen.
At the structural end, there are signs of major reform at NHS England, going further than Amanda Pritchard’s did-she-jump-or-was-she-pushed departure. Wes Streeting is said to be considering the physical return of NHS leadership to the Department of Health and Social Care, promising a “new relationship” between the two entities and with new “Transition CEO” James Mackey explicitly appointed with a remit to “radically reshape” how the system works.
Hopefully, this will be more than just rhetoric. NHS England has more than doubled in size in recent years, amid regular criticism and calls for improvement which have not really been fully taken on board, to put it mildly.
Reform’s ‘Close enough to care’ report last year recommended winding the whole thing down, bringing its essential central functions back under direct ministerial control and devolving the rest to strengthened regional systems.
With little or no money to play with, radical change may quickly become the only option for this Government across a whole complex of policy debates. A boost for GPs and an attempt to reform NHS England: both promising developments, especially if they are signs of things to come.
Read of the week...
My read of the week this time is the “sobering” report from Cavendish Consulting on how house-building is progressing in London. The context here is a very ambitious government plan to build millions of new homes in England. So how are we doing with housebuilding in the capital? Well, not great. This report calls the situation a “timebomb” with an approaching “cliff edge” of “plummeting” housing starts. These scary metaphors do seem justifiable. London’s Boroughs are now pouring £4m each day into temporary housing costs, a 68% increase year-on-year. The number of approved affordable home builds has halved since 2022, with affordable housing starts dropping 88% in the year to March. In some parts of the capital, no new homes have been approved at all by planning committees. So… we seem set to miss London’s housebuilding targets. The only question now is by how many orders of magnitude.