03 Feb 2023

Do White Papers save lives? The potential pros and cons of the new Major Conditions Strategy

Following the controversial announcement of plans for a Major Conditions Strategy, James Juster and Noah Froud examine the rationale for the strategy, as well as the potential downsides for patients and health outcomes of such a policy move.


Last week, Steve Barclay, the Secretary of State for Health and Social Care, announced the Government’s plan for a Major Conditions Strategy.  The announcement has caused controversy in the health policy space, as parliamentary questions have seemingly confirmed that long-awaited policy documents like the Health Disparities White Paper and 10-Year Cancer Plan, amongst others, are scrapped.

While a more cynical reason for the move is that the Government needs to deliver on key issues ahead of an election – long-term plans make no political sense – there are some other reasons which suggest this approach is rational.

The benefits of a simpler, joined-up approach

 In some ways, the de facto consolidation of multiple health strategies into a single centralised document makes sense and fits coherently with the future direction of policy.

The vision for the NHS over the next decade is supposed to be one in which relatively autonomous regionally-based systems are in control – driving change and developing services based on local need.

In an environment where health is becoming increasingly devolved, with Integrated Care Systems (ICSs) established in July 2022 and the ongoing Hewitt Review to help these succeed, it may be right that NHS England (NHSE) and the Department of Health and Social Care (DHSC) are relinquishing some top-down control, using the catch-all strategy to guide, rather than direct, NHS systems.  The detail of a 10-Year Cancer Plan could be seen as micromanagement and the Health Disparities White Paper could be redundant if  ICSs work as they should.

A single consolidated strategy also reduces the risk of incoherence between policy areas. In his statement, Barclay alluded to a Major Conditions Strategy, a piece of health policy, aligning to the life science policy.

Policy workstreams like the Life Science Missions and the Life Science Vision, are supposed to be industrial and science policy as well as health policy. In reality, it has often felt like life science policy has been poorly married with current health service policy priorities. This has led to the Government giving full economic policy backing to certain research and investment projects, while the health service fails to take advantage or support such initatives.

Specific policy saves lives

On the other hand, there is evidence that long-term and condition-specific policy plans do drive meaningful change.

The International Cancer Benchmarking Partnership (ICBP) found that countries with appropriately funded, long-lasting cancer policies see the greatest improvements in cancer survival.  With recent reports that nine in 10 cancer survival rates are worse in the UK than Europe, it seemed like the opportune moment to turn the tide on cancer by introducing the 10-Year Cancer Plan.

Now it seems the fate for these bespoke strategies is sealed and the test is whether a catch-all approach can deliver the same impact.

The Whitehall workforce crisis

As well as an upcoming election and the need to deliver on the Public’s immediate priorities, there is a another reason behind the move to a single strategy. Maintaining relevant and dedicated policies may have benefits, as outlined above, but the reality is that creating, renewing and implementing a plethora of policy strategies takes headcount. Yet, NHSE is looking to reduce headcount and the DHSC has had an effective hiring freeze. As all replacement hires require ministerial approval, developing several strategies, plans and workstreams, has become unrealistic.

Additionally, this is allegedly a DHSC-owned strategy, not one owned by NHSE. This is an interesting development of the themes which came out in debates over the Health and Social Care Act 2022, which ministers hoped would rebalance the relationship between the two bodies and give ministers, and therefore DHSC, more power.

Finally, we should acknowledge that such a move may sour the relationship between DHSC and teams in NHSE which have worked to develop these strategies over the past few years.

By James Juster and Noah Froud

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