Feedback on Health & Social Care discussion

I am pleased to be able to share with you the formal response from Downing Street to our national policy discussion and subsequent roundtable discussion on Health & Social Care.

Dr John Hayward, Policy Director, CPF

17th December 2018

Dear John

We met in recent months, along with James Marshall and Chris Skidmore, to discuss CPF’s Paper 3/2018: Health and Social Care. 

The discussion was very helpful, so thank you to you and the broader CPF network for sharing such a rich set of perspectives.  As you know, the NHS is the Government’s highest spending priority and social care an area where the Department of Health and Social Care (DHSC) is preparing to publish a significant Green Paper.  From the number of CPF groups contributing these are clearly topics that members also feel strongly about.

Following our meeting, we held a roundtable discussion with 15 CPF member from 8 groups, here in 10 Downing Street, to talk through the social care ideas in more detail.  From our perspective, it was a very successful meeting; it is always valuable to hear views directly from members and to feel the passion that lies behind their perspectives.

On behalf of Gavin Barwell as Chief of Staff, and James Marshall, Director of the Prime Minister’s Policy Unit, I am very pleased to enclose formal feedback to a number of issues raised in the key paper.

Paper 3/2018 – Health and Social Care

  1. Overall, it was encouraging to see the key PM priorities for the NHS, which she outlined in her speech in June, coming through as clearly as they do in the paper.   A more integrated, patient focused approach, with a focus on prevention and reducing variation, the value of using technology, the importance of the workforce and the continued path of parity between mental and physical health.  We expect all these to be prominent themes in the NHS Long Term Plan.
  2. The Group’s top policy suggestion is to focus on outcomes and ‘abolish meaningless targets such as the 4 hour maximum A&E waiting time target’.  The PM was clear in her speech in June that she would welcome proposals coming forward from the NHS on how to improve targets, providing the proposals were clinically led.  We expect proposals on this to come forward over the coming months.  Related, the paper in many places refers to the need to focus on outcomes that matter to patients, which we thoroughly agree with.  We will ensure this theme features prominently in the NHS Long Term Plan.
  1. The recommendation that the Secretary of State should have a ‘dedicated ‘Internet of Thing’s team’ has in part already been taken forward.  Matt Hancock announced in September the creation of the HealthTech Advisory Board, to be chaired by Dr Ben Goldacre. The aim of the advisory board is to “highlight where change needs to happen, where best practice isn’t being followed, and be an ideas hub for how we transform the NHS to improve patient outcomes, patient experience, and to make the lives of NHS staff easier.’   I will ask Richard Sloggett, Special Adviser to the SoS in the Department of Health and Social Care to consider this suggestion as a way to support the advisory board.  I will also ask him to consider the long list of ideas you generated on where the NHS could potentially benefit from digitalisation in Question 6 – What NHS Services could be Digital.  There are already plans to launch and NHS App and under Question 3 – Talking More Control of Your Own Health – there are a number of good ideas on the potential functionality of the App. In particular, the use of the App to track and remind people about screening has a lot of merit.  This section also proposed food labelling could be much clearer; this is an area that we are actively considering as we continue to develop our Childhood Obesity Strategy.
  1. In Question 5 – Tackling the Stigma of Mental Health there were a number of excellent ideas.  The ‘Mental Health 5-a Day’ is a fabulous idea – it not only builds on the existing ‘5-a-day’ brand and awareness but also creates a nice step to parity between physical and mental health.  We will feed this idea into DSHC to consider as part of the work they are doing on a Prevention Green Paper planned for next year.  We also agree with the observation that social isolation can be an overlooked issue, and the potential value of social prescribing.  The PM announced the NHS would expand social prescribing nationwide by 23/24 as part of the Loneliness Strategy and the NHS Long Term Plan will provide more details.
  1. In Question 7 – Encouraging People to Work for the NHS - we note the high number of groups that called for State Enrolled Nurse system to be re-introduced.  This Government introduced Nursing Associates – a similar concept as a non-degree route into nursing – and the first cohort will finish their two-year training course over the coming months.  These courses have proved popular and DHSC is considering whether to expand further the capacity of these courses.
  1. We agree with the need for more care to be community based; the paper refers to extending primary care hours, revitalising cottage hospitals, more rehabilitation centres, hospices and community services in various places.  The PM announced in November that the funding of primary care and community services will rise as a share of the NHS budget and we expect further details on this as part of the NHS Long Term Plan.
  1. We note that 37% of groups thought there was a need to work out what the NHS should not cover.  We agree that there are a number of low value procedures and the Academy of Royal Colleges is supporting a Choose Wisely campaign aimed at identifying areas where medical intervention is not appropriate but there may be more that can be done and note the suggestion around drugs that are cheaper over the counter.  We will pass these suggestions to Richard Sloggett to consider further.
  1. The paper, and the roundtable, raised a number of points around social care, all of which we will feed into the DHSC team working on the Green Paper.  A few thoughts below:
    1. The groups are right to flag that ‘myth busting’ is part of the challenge with social care with so many people assuming it is free at the point of need;
    2. The local ‘annual report’ is an interesting idea;  we agree that there needs to be greater transparency on spend and performance at a local level;
    3. We agree that the inability to ‘insure’ against care costs is an issue and we expect the Green Paper to explore this challenge;
    4. Other ideas, such as Care ISA, Equity Release, savings bond, retirement care levy we will feed into the team to test their feasibility.
  1. There are several housing suggestions in the paper; ‘pay to sell’, freeing up the planning system to all the building of extensions to accommodate elderly relatives, encouraging three generational homes.  I will ask our special adviser for housing, Toby Lloyd, to consider further and provide more detailed follow up.

Thank you again for harnessing the collective power of the Conservative Policy Forum, for a rich policy paper, and for those members who gave additional time to attend the roundtable on social care. 

As we discussed when we met recently to consider the work plan for CPF in 2019, both James Marshall and I are very keen indeed to explore as many ways as possible to ensure great policy ideas are fed directly into the heart of government. You provide a vital link for our members to be able to do that and for their voices to be heard, and we want to continue to work with you to keep enriching that process

Best wishes,

Dr James Kent
Deputy Director of the Prime Minister’s Policy Unit
Special Adviser on Health and Social Care


  • George Freeman MP, CPF Chairman
  • Rt Hon Gavin Barwell MP, Chief of Staff, No10
  • James Marshall, Director of the Prime Minister’s Policy Unit, No10
  • Toby Lloyd, Special Adviser, No10
  • Richard Sloggett, Special Adviser, DHSC