Archive for June, 2022

Representation matters: reflections in Pride Month

Posted on: June 30th, 2022 by Tomas White

We are now approaching the end of Pride month, which in customary fashion has been marked by worldwide celebrations of queer love, and an alarming number of brands adopting rainbows – from the iconic M&S Pride Sandwich to the slightly short of the mark Burger King Whopper. As we mark the 50th anniversary of the UK’s first pride march, this month has marked a celebration of all the progress that has been made towards a world where LGBTQIA+ individuals can be themselves and live their lives to the full.

It has also been a stark reminder of how far we still need to go – with devastating news from Oslo  on Saturday, and the Supreme Court’s ruling on Roe vs Wade marking a fundamental attack on human rights, throwing other established rights like gay marriage into doubt, in the US at least.

There have been moments of joy. I’ve just returned from Glastonbury, where Olly Alexander followed up his phenomenal 2019 pride speech (a must watch, if you haven’t seen it before) with his affirmation that he loves being gay, and “can’t recommend it enough”. Last weekend, Dame Kelly Holmes came out as gay. Her interviews and the press that surrounded it, and the follow up documentary released this weekend, demonstrate why coming out matters and the huge struggle of having to hide who you are.

Dame Kelly spoke at length about the impact her struggles around her sexuality had had on her mental health – exacerbated by her position as arguably the highest-profile British athlete of her generation. She’s not alone. According to NHS England, the evidence that LGBT people have disproportionately worse health outcomes and experiences of healthcare is “both compelling and consistent”. According to Rethink Mental Illness, LGBTQIA+ people are 1½ times more likely to develop depression and anxiety compared to the rest of the population, and face higher risk of suicidal behaviour and self-harm. The impacts stretch beyond mental health: according to NHS Digital, higher rates of LGB adults report bad or very bad health compared to heterosexual adults.

The reasons for this are complex – but include the experiences that LGBTQIA+ people will often have to deal with as a minority community, including stigma, prejudice and discrimination. Certainly, in Dame Kelly’s case, the combination of discrimination and stigma contributed to what she described as “28 years of heartbreak”. Stonewall’s research reveals almost one in four LGBT people have witnessed discriminatory or negative remarked by healthcare staff, and one in seven have avoided treatment for fear of discrimination. The situation for the trans community is even more complex: 45% of transgender individuals responding to Stonewall’s survey said healthcare staff lacked understanding of their health needs, and 24% fear discrimination from a healthcare provider. Outside of a healthcare setting, Stonewall’s research shows that almost one in five LGBT staff have been the target of negative comments or conduct from work colleagues because they are LGBT. One in eight trans people have been physically attacked by customers or colleagues, and one in ten (10%) black, Asian and minority ethnic LGBT staff have similarly been physically attacked because of their sexual orientation and/or gender identity – compared to 3% of white LGBT staff.

As a health policy practitioner and queer woman, I could have written a pride blog about many things – like LGBTQIA+ icons who have helped to change policy or the continued LGBTQIA+ health inequalities I touched on briefly above. But what Dame Kelly’s decision – and some of my own experiences over the course of my career to date – have made me realise is that actually what I wanted to write a blog about is the reasons why I’m proud to be open about my sexuality in the workplace.

Everyone has their own levels of comfort about what they want to share and I wholeheartedly support that. For me, having taken a while to get to the point, being authentic to myself at work means my life is easier, and I can do my best work. It matters to me because when I was younger it would have made a huge difference to me to have a representative figure to look up to – both at school and in the workplace. I am immensely lucky to work for an organisation which supports me and makes me feel comfortable enough to bring my whole self to work – and I’m happy to play a very small part in trying to make workplaces a more diverse and inclusive space. If recent events, and Kelly Holmes’ experience teach us anything, it is that representation and inclusion matters – and we can all play a role in helping to making that a reality.

Scottish independence: Nicola Sturgeon goes for broke in bid for second referendum

Posted on: June 29th, 2022 by Tomas White

What’s happened?

Depending on your constitutional point of view, Nicola Sturgeon has either blindsided the UK Government with a great leap forward towards the promised land or has reprised her role as the Grand Old Duke of York to keep her agitated supporters on side.

Speaking at Holyrood yesterday, the First Minister said that the Scottish Government will legislate for a nonbinding referendum on independence to take place on October 19th 2023. Allied to this, the Scottish Government has written to the UK’s Supreme Court, asking it to rule on its legality. Hearings are expected to begin in September this year, with a ruling possible before the end of the year.

If the Scottish Government loses that court case – and indeed, the bulk of informed legal opinion suggests it will – Sturgeon said the next UK-wide General Election would become a “de-facto independence referendum”. Should the SNP and their fellow travellers in the nationalist cause, the Scottish Greens, win more than 50% of the vote, then they would claim that is a mandate to enter independence negotiations with the UK Government.

What does it mean?

Nicola Sturgeon has often been criticised by her nationalist critics for a tendency towards gradualism on the question of a second referendum. Yesterday’s move, a form of shortbread and circuses for the nationalist movement, has provided it with a renewed focus.

However, the legality of her gamble appear dubious. If in all likelihood, the Supreme Court rejects the Scottish Government’s legal case, the notion that a General Election result of 50.1% of the vote could be used as a surrogate for a legal referendum brings the SNP dangerously close to Catalan territory. Attempting to force the issue unilaterally has the clear potential to backfire both domestically and internationally – polling has suggested that just a third of Scottish voters view having a referendum anytime soon as a priority while the EU, as evidenced by its response to the illegal Catalan referendum of 2017, does not take kindly to separatist movements and potential membership candidates breaking conventional constitutional norms.

Sturgeon has in some ways amplified the element of risk which turned off so many voters from voting Yes in 2014. In setting out this breakneck timetable, it remains something of a moot point whether the Scottish Government and its civil servants will be able to provide a detailed plan encompassing currency, pensions, defence, trade, EU membership et al. given the many valid concerns which exist about their ability to discharge their relatively simple devolved obligations.

What next?

The UK Government remain implacable on the issue of another referendum and will likely use any Supreme Court ruling in their favour as the ballast for that opinion. The nationalists will obviously seek to spin this as the “Westminster establishment” keeping Scotland imprisoned in the UK against its will.

The unionist response will be interesting – while it would be easy for them to blank an unsanctioned referendum, they cannot do that to a UK-wide General Election. Arguably, they should pursue a degree of pugnaciousness to point out the flaws in the nationalist prospectus when it appears rather than simply ignoring this as a tantrum by a leader and a movement which has run out of road and ideas.

Equally, the return of the Scottish question as a key election issue at a time of rising English consciousness could give the Conservatives an unlikely boon in support. This is especially true if they are able to portray Labour and Keir Starmer as willing to form a “coalition of chaos” with the SNP – this is despite Starmer being at pains to bolster his unionists credentials during his time as leader. An overtly English campaign from the Conservatives would in all likelihood play very badly in Scotland to the detriment of unionism there.

Expect months of posturing ahead which will suck all the oxygen in Scottish political and public life towards it. Many will argue that this effort could be better directed towards some of the more pressing issues facing Scotland – it was not unnoticed that to make way for Sturgeon’s statement, a debate on Scotland’s drugs deaths was shunted down the Holyrood agenda yesterday.

A formidable in-tray – from Covid response, to driving cross-NHS cultural change

Posted on: June 28th, 2022 by Tomas White

The pandemic is far from over, unlocking the lockdown is proving a game of snakes and ladders. Javid has already been warned that his first priority needs to be the continued success of the vaccination programme if we are ever to see our lives return to normal.

Ensuring the NHS has the resilience necessary to face any future waves of new Covid variants is also pressing. Tackling burgeoning waiting lists will be a very visible litmus test for Javid. More than 5.1 million patients in England are waiting for treatment, the highest since modern records began, and the number is likely to keep on going up as Covid admissions continue to disrupt the recovery of other services like cancer care and routine surgery.

The list of operational challenges is growing. The coming winter could be as challenging as the last though in different ways.

Flu was effectively suppressed last winter thanks to social distancing. That means less residual population immunity and medical experts have warned that the coming winter could see a nasty resurgence of flu.

The last bad flu season was in 2018 and then – even before Covid existed – there were widespread suspensions of routine operations and procedures.

The rollout of booster Covid jabs in the autumn and linking that to the flu campaign could be even more complex than what’s been run up until now.

These challenges are compounded because NHS and social care staff and leaders are exhausted from dealing with the pandemic. But there is no quick relief in sight with multi-year training required for new doctors and nurses. There is also a very tricky decision to make on pay soon following an outcry after an earlier 1% pay offer to many health workers.

And the list of strategic challenges is daunting.

The reform of social care has been left in the ‘too difficult to do’ drawer by successive Governments. Yet landing the integration agenda requires a Long Term Plan for social care. Javid’s Treasury experience could stand him in good stead when he sits down with the PM and Chancellor to agree a plan.

Within days Javid will have to kick off the Parliamentary scrutiny of the Health Bill. Any delay will spell trouble for an ambitious timetable that sees Integrated Care Systems (ICS) formally established from 1st April 2022.

Unlike the 2012 reforms the move to integrated, place based care and population health has NHS backing. But Javid will have to decide whether he sticks with Hancock’s plans to take new powers to direct NHS England. There were already rumblings on the Conservative backbenches about the plan, is this a fight Javid wants to have?

And with Sir Simon due to step down as NHS England CEO this summer Javid and his boss the PM will have to decide what sort of ‘guiding mind’ they want at the top of the NHS. How long will the leash be?

All this while the UK Health Security Agency is being set up and absorbing some of the work of key agencies involved in the pandemic response, such as NHS Test and Trace and Public Health England.

Steering the Health Bill through Parliament won’t be without its challenges, especially in the Lords. But it will be its implementation and impact that the public will judge.

The centre always has to resist a strong temptation to micro-manage the NHS, both from the Department and from NHS England. But the ICS project is predicated on a very different model of place-based collaboration and system leadership to deliver more person-centred care, make a reality of prevention and tackle inequalities of access and outcome.

Without the culture change the new structures will fall short of the ambition looking up for direction rather than out to the communities they serve. Appointing an NHS CEO who can foster that culture, manage political expectations and let the ICS reforms mature and deliver may be the most important NHS legacy of Javid’s tenure.

Tories lose by-elections to Labour and Lib Dems

Posted on: June 24th, 2022 by Tomas White

Boris Johnson has been dealt a significant blow this morning with the loss of two by-elections. Labour took back the red wall seat of Wakefield with a 12.7% swing and the Lib Dems took Tiverton and Honiton with a massive swing of almost 30%.

The double defeat, in two very different constituencies, is a hit to the PM’s reputation as a vote winner – a key factor in his MPs’ minds when they consider if he is the man to lead them into the next election.

Boris loyalist Oliver Dowden resigned as party chairman this morning saying the Tories could not carry on with business as usual and “somebody must take responsibility”.

The PM has promised to listen to what people are saying but pledged to “keep going”.

With Labour leader Sir Keir Starmer saying the result shows the country has lost confidence in the Tories and his Lib Dem counterpart Sir Ed Davey hailing “the biggest by-election victory our country has ever seen”, Chris Hopkins of our sister company Savanta ComRes gives his top 10 takeaways from Boris’ bad night:

  1. In my last by-election analysis I started by congratulating the Liberal Democrats for overturning a seat that required the 7th biggest by-election swing of all time. I better start this one in similar fashion, by congratulating them on a truly remarkable victory that this time marked the third largest by-election swing of all time, overturning a 24,000+ majority, and planting a stake in the ground in their former ‘heartland’ – as much as the Lib Dems have ever had a heartland – of South West England, eroded over recent elections by the Conservatives. Make no mistake though; South West or not, this is Conservative territory, and the Lib Dems have won it relatively comfortably.
  2. I said that the North Shropshire “walloping” suffered by the Conservatives at the hands of their former coalition bedfellows was “no ordinary by-election defeat suffered by an incumbent government”. In terms of the sheer numbers, this victory is bigger, yet it doesn’t feel quite as momentous. This is a government on the rocks, with Partygate and sleaze allegations that brought about the North Shropshire defeat acting as the shot to a continued poor polling performance, vote of no confidence and cost of living crisis chaser that brings about this latest defeat.
  3. So while it perhaps doesn’t feel as momentous – after all, the Liberal Democrats were favourites to win this by-election with the bookies before the writ was even moved – the knock-on effect of this one could be huge. Conservative MPs waking up this morning, seeing a 24,000+ majority get overturned, the second 20,000+ majority to be lost since Partygate broke, and coming to the perfectly reasonable assumption that their supposedly safe seat could be vulnerable. Yes, this is a by-election, and usual by-election rules apply, but 290-odd Conservative MPs have a seat less secure than Tiverton and Honiton, and the sheer scale of this defeat is bound to restart murmurings of coups to oust the Prime Minister.
  4. Chronologically, the Tiverton and Honiton result came after the one in Wakefield, but I’ll use some artistic licence to say that Wakefield serves to compound the Conservative misery on Friday morning. Labour winning back this seat after losing it in 2019 for the first time since the 1930s is naturally significant, and given its position in the Red Wall, the 2019 Conservative intake of MPs will also be looking especially nervously over their shoulder at their prospects of retaining their seat at the next election.
  5. With uniform national swing, given where the two main parties are in the national polls and the relatively slim Conservative majorities across the Red Wall, many Red Wall seats would be vulnerable to switching back to Labour at the next election anyway, but the scale of this victory – an 18pt majority – outperforms Labour’s national poll lead. Again, normal by-election rules apply, knowing that this is extremely unlikely to be extrapolated at a General Election, but it would have been all-too-easy for Labour to, well, labour to an underwhelming victory here. In the end, they blew the Conservatives away.
  6. Poor vetting and ill-discipline caused these by-elections, and Conservative Party chair Oliver Dowden resigned after losing both of them this morning, citing “a run of very poor results” that presumably includes North Shropshire, the local elections, and 41% of the parliamentary party expressing no confidence in the leader. The Conservative Party will need a new plan heading into the next election, and on this evidence it’s going to take a lot more than a Rwanda plan and bashing trade unions to firm up the base.
  7. But where do the Conservatives go from here? It’s hard to imagine any policy platform really is enough to turn things around. In the last six-to-eight months, the leader’s popularity has sunk like a stone, the leader-in-waiting’s popularity suffered a similar fate, perceptions of economic competence have been ceded to *checks notes* the Labour Party amid a cost of living crisis that shows no end in sight, and two fifths of your parliamentary party recently said they had no confidence in the party leadership. The electorate does not reward divided parties at the ballot box. The electorate does not reward perceived economic incompetence at the ballot box. The electorate does not reward unpopular incumbent Prime Ministers at the ballot box. That’s a triumvirate of terror the Conservatives have to address.
  8. The Conservative Party therefore finds itself in this weird, almost Labour-esque position where its best chance of success is the other party not being good enough. Labour’s milquetoast leadership has felt like it’s just been waiting for a Conservative collapse to win by default. In doing so, voters are still unenamoured with Keir Starmer and the party as a whole, and therefore the Conservatives perhaps still stand a chance. If they can convince voters not that the Conservatives are the solution, but that Labour definitely are not, maybe they can limp to another election victory by being the least worst. Johnson vs Starmer feels like a race to the bottom worse than Cameron vs Miliband.
  9. The Conservatives can limp to victory if, and only if, the electoral maths allows it. A strange but significant phenomenon in these by-elections were that in Tiverton & Honiton, the Lib Dems won with a big swing and Labour lost their deposit; in Wakefield, Labour won with a decent swing and the Lib Dems lost their deposit. If this scale of tactical voting played out at a General Election, the Conservatives are in a battle in basically every seat, while Labour and the Liberal Democrats can concentrate resources where they’re needed most. While tactical voting is much more pronounced at by-elections, the two parties working in cahoots to oust the Conservatives at the next election is potentially a win-win for both Labour and the Liberal Democrats.
  10. I’m on annual leave today, off to see Elton John at Hyde Park, so how on earth can I shoehorn some sort of pun into this column? Something about a Lib Dem Yellow Brick Road? I guess that’s why they call it the blue wall? The Prime Minister’s still standing? They’re all terrible, so I can only end this column by apologising; but sometimes sorry seems to be the hardest word.

Health and Social Care Data Strategy: Unlocking capital investment to create a data-driven healthcare system for all

Posted on: June 21st, 2022 by Tomas White

Last week, the Department for Health and Social Care published their bold and ambitious health data strategy, Data saves lives: reshaping health and social care with data.  The long-anticipated strategy builds on the data-driven power and innovation seen during the pandemic.  It aims to transform the way data is used to drive breakthroughs and efficiencies, helping to tackle the COVID-19 backlog and create a healthcare system that Sajid Javid would deem fit for ‘the age of Netflix’.

The pandemic transformed the use of healthcare data to help systems overcome the challenges posed by COVID-19.  For instance, data was used for remote monitoring to monitor patients from the comfort of their own home, which enabled speedier hospital discharge and prevented many readmissions.  Data was central to understanding the indirect effects of COVID-19 on other diseases including cancer, creating a picture of the burden of missed care, and informing strategies for staffing, resources, and policy to curb the effects on healthcare outcomes.[i]

Building on the data gains seen during the pandemic’s state of crisis is more important than ever.  Almost 6.4 million people are sat on the NHS waiting list, with Sajid Javid, Secretary of State for Health and Social Care, openly acknowledging the backlog is set to ‘get worse before it gets better’.  The publication of a data strategy alone will not hasten the inception of a fair, equitable NHS for all in the age of Netflix – albeit it is a starting point and demonstrates the Government’s intent.

One concern the Government should be acutely aware of is ensuring the strategy does not widen health inequalities.  For instance, the hope is that by March 2024 75 per cent of the adult population will be registered to use the NHS App to improve patient access to GP records, enabling better management of their health.  But some patients with greater healthcare needs – particularly the elderly – are not usually attached to smartphones in the same way younger, generally healthier people are.  What this may mean then is digitally illiterate patients will not be able or will find it more difficult to take advantage of the ‘one stop shop’, while the younger, more digitally aware can pop to the ‘shop’ for appointments, repeat prescriptions and medical records with ease.  As the path is set for growing reliance on digital, the underserved and digitally illiterate need to be at the forefront of mind in policy implementation otherwise the rift in health care access and outcomes will grow.

Following the recent introduction of The Health and Care Act, Integrated Care Systems (ICSs) – due to be put on a statutory footing on 1 July – will be at the forefront of implementing the data strategy in their local systems.  The strategy plans to bring data together across the NHS and social care, to allow ICSs to improve decision making and have a clearer picture of population health – including unequal outcomes and access – in their system.  Closing this divide is no easy task, it requires capital.

The capital investment in data infrastructure necessary to transform health and social care from a ‘blockbuster’ to ‘Netflix’ model is massive.  System decision makers will surely welcome the promised £25 million over 2022/23 to support implementation of digital social care technology across England to enable data capture and sharing between settings.[ii]  But they may be stumped that the Government feel the NHS ‘doesn’t need any more money’ given the undertaking the strategy represents.[iii]  While there were increases in capital funding in the 2021 Spending Review, these fall short of what is needed to stem the tide of the lack of investment over the last decade.[iv]

In an environment where the Treasury has a tightened hold on finances, can we really expect the data strategy to make substantial inroads on the growing waiting list without leaving anyone behind?  If health outcomes and access for all are to improve, health inequalities must be at the forefront of implementation and capital funding unlocked to fully realise the potential of data in health and social care.

[i] Banerjee, A., Sudlow, C., Lawler, M. Indirect effects of the pandemic: highlighting the need for data-driven policy and preparedness. Journal of the Royal Society of Medicine. May 2022. Available at: https://doi.org/10.1177/01410768221095245.

[ii] Fo, A. New data strategy aims to ‘close digital divide’ between NHS and social care. The Independent. 13 June 2022.

[iii] Skopeliti, C. NHS ‘doesn’t need any more money’, says Sajid Javid as waiting lists rise. The Guardian. 11 June 2022.

[iv] NHS Confederation. Unlocking capital funding: improving patient safety and reducing the backlog. 14 June 2022.