Sunak’s measures: What do they look like, where’s the money coming from and how do they compare to other countries’?

9 Jul

The public has fast become used to radical economic announcements from Rishi Sunak, starting with his budget in March, and yesterday was no different in terms of shock factor. Standing in the House of Commons, he laid out how the Government will further try to ease the economic damage from Coronavirus, in a £30 billion plan. “We need to be creative”, he said, and he did not disappoint.

In the immediate, Sunak wants to stop a wave of mass unemployment. To do this, the Government will incentivise firms to hang onto their employees – paying them a £1,000 bonus for every staff member kept on for three months after the furlough scheme ends (as long as they are paid a minimum of £520 on average each month between November and January).

Sunak’s employment measures are especially geared towards the young, who have already been badly affected by the Covid-19 fall out. The Government will spend £2 billion on a “kickstart” work placement scheme, to get up to 300,000 16 to 24-year-olds into employment, as well as paying firms a £2,000 apprenticeship bonus for each new apprenticeship they create over the next six months.

Sunak is also keen to breathe life into the hardest-hit sectors. To boost the hospitality industry, he has cut VAT on food, accommodation and attractions from 20 to five per cent from next Wednesday. The measure will remain in place for six months, will benefit an estimated 150,000 businesses and is said to cost about £4 billion

Perhaps the most memorable announcement from his budget is the “Eat Out to Help Out” scheme. It means that anyone visiting a restaurant or pub between Monday and Wednesday in August can get up to 50 per cent off their bill, with a maximum of £10 per customer. Businesses can then claim the money back from the Government.

How much will it cost?

None of this is cheap, of course. The Institute of Fiscal Studies (IFS) suggests that borrowing will exceed £350 billion as a combined result of previously-announced policies and the recession. The FT estimates that the deficit will reach 18 per cent of national income, and will be almost twice the size of the deficit at its peak in the 2008-09 global financial crisis.

Aside from borrowing, many details remain unknown as to how this will be paid back, and where Sunak’s plans are ultimately leading us. John O’Connell, Chief Executive of the TaxPayers’ Alliance, told ConservativeHome today: “Tax receipts have absolutely plummeted since the arrival of coronavirus. Total HMRC receipts in April and May 2020 were £45.2 billion lower than the previous year.

“At the same time, the OBR estimates that the total cost of the job retention scheme could exceed £50 billion by the time it ends in October. To pay for these massive shortfalls the Debt Management Office revealed that Britain is set to sell a record £275 billion of government debt in just five months between April and August. Incredibly, this is more than two and a half times the gilt sales for the previous financial year.”

He added: “As usual there have been calls for taxes to rise to balance the books but this isn’t sensible or feasible when the tax burden is already at a 50-year high. The last thing we need is to inflict austerity on taxpayers. It would be far better to eradicate wasteful spending and grow the economy by slashing taxes and cutting red tape.”

As ConservativeHome reported yesterday, centre-right think tanks have generally been concerned about the tax burden. Following yesterday’s announcement, Sunak was quizzed on LBC about whether there would be tax rises, which he did not rule out.

What do economic measures look like elsewhere?

While there are concerns about how enormous Britain’s payments will be, the UK’s stimulus actually puts the country “in the middle of the pack” of spending when compared to others across the world. Data from the Resolution Foundation measuring countries on the size of their fiscal response to coronavirus as a proportion of GDP (as of June 2020) puts the UK behind the US, Germany, Japan and Australia, but above Canada, France, the Netherlands and Italy.

Other data from Bruegel Datasets is around ‘discretionary fiscal measures adopted in response to coronavirus’ by June 15 2020, as a percentage of 2019 GDP, with UK standing at 4.8 per cent; the US at 9.1 per cent and Hungary at 0.4 per cent, alongside other countries.

So while Sunak’s measures look drastic, it’s worth remembering that the UK’s economic snapshot cannot be taken as a standalone, as others are taking serious action too. The eventual cost for the UK, and what happens next in the pandemic, is anyone’s guess.

Stamp duty cut welcome, but concerns about “tomorrow’s taxpayers”. Centre-right think tanks react to Sunak statement.

8 Jul

Adam Smith Institute –  Matthew Lesh, Head of Research, said:

“Stamp duty is Britain’s worst tax. This temporary cut is the right move at the right time to get Britain moving. Temporary measures to get young people work experience, to build inwork skills, are also welcome in the face of an increased minimum wage.

“Furlough continues for a few more months but reality will hit eventually. In the forthcoming Budget, the Chancellor should cut the cost of hiring by permanently reducing the burden of employers’ national insurance, remove red tape like occupational licenses, and abolish the factory tax to get businesses investing in their futures.

“The stimulus proposals are very questionable. The VAT cut and subsidising restaurants will be expensive and provide limited benefit. People aren’t spending on food, accommodation and attractions because of safety concerns, not lack of demand or cash.”

Centre for Policy Studies – Robert Colvile, Director, said:

“We welcome the focus on jobs and training, which is what the CPS recently called for in our report ‘After the Virus‘, but the challenge will be how to support the economy as we transition to new ways of working in a post-virus economy.

“You can see the Government is trying to strike that balance with this package, but these measures are temporary, and will have to be paid for down the line. This is why we would like to see the sort of long-term structural change that will maximise growth, support businesses and encourage them to create new jobs without placing the burden on the taxpayer.”

TaxPayers’ Alliance – John O’Connell, Chief Executive, said:

“The chancellor announced a ‘plan for jobs’ but it’s tomorrow’s taxpayers who will have to work hard to pay for it all.

“While the jobs retention bonus will help ensure that the furlough scheme isn’t just an expensive pause on mass lay-offs, taxpayers will be concerned about how and when they will pay the bills for ever-more spending promises.

“It is cheering that the chancellor appreciates the economic benefits of cutting taxes and in particular lifting the stamp duty threshold will provide a boon to the housing market.

“That said, while easing the burden on taxpayers is always welcome, we must look at longer-term tax simplification and put a stop to temporary fiddles.”

Institute of Economic Affairs – Professor Syed Kamall, Academic and Research Director, said:

“We are in an unprecedented situation and there remains the issue that many individuals and families are fearful of leaving their homes to resume every day activities. The Chancellor can only do so much in terms of measures introduced to get the economy moving.

“The cut to Stamp Duty is welcome but why isn’t it permanent? It is a destructive, regressive tax that clogs up the housing market and limits labour mobility. Making it permanent would get the property market moving and encourage those who want to downsize as well as those looking for family houses, freeing up homes for first-time buyers.

“It is disappointing more was not announced to encourage private investment in infrastructure – such as reopening old railways or rezoning to allow homes to be built in places being vacated by shops, such as high streets.”

Resolution Foundation – Torsten Bell, Chief Executive, said:

“Today’s Budget in-all-but-name was a £30 billion top up to a pandemic response that is approaching 10 per cent of GDP and will push borrowing to around £350 billion this year.

“The focus on jobs and some, but not all, hard-hit sectors was very welcome. Kickstart jobs for young people represents a tried and tested policy, but the new Job Retention Bonus is poorly targeted at those jobs that are most at risk of being lost.

“The Chancellor is right to focus VAT cuts on food, accommodation and attractions. However, the lack of support for face-to-face retail means significant challenges for Britain’s High Streets. The innovative meal deal voucher scheme is far too small scale to make a significant difference.

 “The Chancellor, having previously announced huge measures to protect household incomes, has now set out much more normal demand support for the next phase of this crisis. That might be sufficient if the UK sees the V-shaped recovery we all hope fora. But given that this economic crisis is likely to be with us until a vaccine is found, he should expect to be returning with further measures to support the economy in the Autumn.”

Tania Mathias: Social care reform should be Johnson’s legacy as much as Brexit

6 Jul

Tania Mathias is an NHS doctor and former MP for Twickenham.

At the weekend Sir Simon Stevens deftly moved away from the problems during the current pandemic – that have led to NHS doctors protesting outside Downing Street, fears about the lack of PPE, and the paucity of testing – by commenting on the much needed reform of social care which had been highlighted well before SARS-CoV-2 had reached its human host.

Many clapped for the NHS at five o’clock on Sunday. Next year, if we have had progress in medical and social care integration, it could be a clap for NHSCARE.

Theresa May’s manifesto in 2017 addressed the need for social care reform, and we have had a Green Paper promised ever since. Now is a perfect rainbow: we need more people opting to work in the social care sector, and many people in retail and hospitality are facing the need to re-train and look for other jobs. If we can ride the wave of respect and current attention on the NHS, we can direct people seeking work to the care sector.

This year is the opportunity to give more status – financially and culturally – to jobs involving person-to-person care. Several Cabinet Ministers have spoken about the challenge of the fourth industrial revolution. High tech jobs are a dominant need in our society yet the often missed need is the “high touch” or empathetic jobs that are needed yet no artificial intelligence can mimic.

People do not need to have a calling or a vocation to be able to look after another human being who is in need of personal care. The new Job Centre mentors need to look to filling care jobs that also have a career structure to help the thousands of people who suddenly find themselves unemployed.

The Cavendish report addressed the need for a better career structure for care workers. Indeed, better training may have saved lives during this first pandemic peak. For example, who saw the images of the fire brigade workers training care workers how to put on PPE and wondered shouldn’t the care worker being the one to teach the fire brigade how to do this?

Care has been an overlooked career but now is a rainbow opportunity to bring a range of people from different life and job experiences into the care sector to fill vacancies. Instead of furlough, the Government could be subsidising the wages for people entering the care sector.

Longer term the Government could be encouraging companies to give their skills to the care sector. The Territorial Army is a template and now we have a chance to move some of the COVID-19 volunteers into a NHSCARE army, or rather NHSCARE family.

Sir Simon Stevens referenced Beveridge’s five evils. And I am told Margaret Thatcher kept a copy of Beveridge’s report in her famous handbag. I don’t care if that latter anecdote is true or not: the point is Thatcher cared deeply about the end to want, disease, ignorance squalor and idleness. A boost in recruitment in the care sector can address several of these issues at once.

Prime Minister Boris Johnson’s term of office was expected to be dominated by Brexit. A greater legacy will be a care sector fit for the next 72 years and integrated with a stronger NHS – the birth of NHSCARE. Thatcher would be proud methinks.

Phillipa Stroud: Coronavirus has hit those in poverty hardest. The Government must support employment, fast.

2 Jul

Baroness Philippa Stroud, Chair of the Social Metrics Commission.

The UK is living through the most significant health, social and economic crisis of modern times. But not everybody is being impacted by the Coronavirus pandemic in the same way. A new report from the Social Metrics Commission (SMC), which I chair, shows that those who were already struggling to make ends meet are being hit hardest.

Research we conducted with YouGov reveals that almost two thirds (65 per cent) of those who were living in deep poverty – that is, more than 50 per cent below the poverty line – and were employed before the virus hit have lost their jobs, been furloughed, or seen their hours and/or wages drop. This compares to just over a third (35 per cent) of those living more than 20 per cent above the poverty line prior to the crisis.

Our analysis shows that, over the last 20 years, rising employment rates for those in poverty were helping families move out of deep poverty, so they were more likely to be able to escape poverty in the future.

Families in poverty where the adults work full-time are less than half as likely to experience deep poverty than those with part-time work or no job. A reversal of this success story could have a profound effect; increasing poverty rates and deepening poverty for those already below the poverty line. So supporting employment, especially for those on the lowest incomes, must remain a key priority for Government as the country emerges from the lockdown restrictions that have caused the economy to contract so severely.

We also need to empower those in or at risk of poverty to increase their financial resilience. The SMC’s analysis shows that, before the crisis hit, nearly three in ten people in poverty lived in families that were behind paying the bills and seven in ten were in families where no-one saves. This means they did not have a buffer available to them when the pandemic struck and are therefore more likely to have fallen further into poverty.

However, it is not all bad news. The SMC’s analysis also shows that, after rising for the last three years, the poverty rate for both children and pensioners had plateaued before the crisis, and that, since the turn of the millennium, poverty levels haves fallen for lone-parent families.

In addition, there has been a drop in the poverty rate for families that include a disabled child over the last 10 years, and across all age groups there has been a fall in the proportion of people in poverty who are also in persistent poverty.

These success stories demonstrate that poverty can be tackled and reduced. But with millions of people still in poverty, we cannot be complacent.

The first step is to ensure that poverty is properly measured. This is essential if action is going to be taken to improve the lives of those currently living in, or at risk of falling into, poverty, and to ensure that those individuals, families, communities, and areas of the UK that have historically been left behind are supported to improve their situation.

After decades of damaging debate that has distracted focus away from the vital action needed to drive better outcomes for the most disadvantaged in society, a new consensus is needed so that policymakers and politicians can track progress and can be held to account.

I am delighted that the Government has committed to creating new experimental national statistics based on the SMC’s approach, as the first step towards adopting it as an official measure.

While it is entirely appropriate that this work was paused during the pandemic so the Government could focus on providing support to those individuals and families whose health and livelihoods have been impacted by the virus, the need to return to it is clear.

The next step is for a full Poverty Commission to be established to develop solutions based on this measurement data. We already know that poverty is more likely to be experienced by some families than others, and that the nature of that experience is incredibly varied.

The causes and implications of the various types of poverty are different, which means that the approach needed to tackle them will be different. As with the SMC, it will be important that the Poverty Commission has support from individuals and organisations across the political spectrum as well as from business, the charity sector, and those who are in poverty.

However, while the Poverty Commission will need to conduct further work to assess what really creates an enabling environment for different people, the existing data clearly shows that work is one of the most effective pathways out of poverty. Therefore, as the country emerges from the coronavirus pandemic, an employment- and skills-based recovery will be vital.

We must enable the smooth transition of those on low incomes who have been furloughed and need to increase their hours, to avoid them falling deeper into poverty. We need to re-open schools so that the education of the poorest is protected and to allow their parents to work the extra hours that could make all the difference.

And we need to ensure that schools are preparing students for the jobs that will be available in the future, equipping them with the skills they will need in a world of artificial intelligence and new digital technologies.

In addition, given half of those in poverty live in a family with a disabled person, we must increase support to help those with disabilities find full-time employment. The inescapable cost of housing, and especially private renting, is also one of the major factors contributing to poverty, so it is also vital that we make housing more affordable.

My hope is that the SMC’s poverty measurement framework can inform the creation of a comprehensive anti-poverty strategy. Where there are obstacles, we need to remove them, and where individuals can build their own pathway out of poverty, we need to ensure that they have the tools and support they need to do so.

This will require a partnership between those in poverty and policymakers, business leaders, and community builders across the UK. Together we can ensure that poverty is less prevalent in the UK after the coronavirus crisis than it was before and that as many people as possible can enjoy a life free of poverty in the future.

Phillipa Stroud: Coronavirus has hit those in poverty hardest. The Government must support employment, fast.

2 Jul

Baroness Philippa Stroud, Chair of the Social Metrics Commission.

The UK is living through the most significant health, social and economic crisis of modern times. But not everybody is being impacted by the Coronavirus pandemic in the same way. A new report from the Social Metrics Commission (SMC), which I chair, shows that those who were already struggling to make ends meet are being hit hardest.

Research we conducted with YouGov reveals that almost two thirds (65 per cent) of those who were living in deep poverty – that is, more than 50 per cent below the poverty line – and were employed before the virus hit have lost their jobs, been furloughed, or seen their hours and/or wages drop. This compares to just over a third (35 per cent) of those living more than 20 per cent above the poverty line prior to the crisis.

Our analysis shows that, over the last 20 years, rising employment rates for those in poverty were helping families move out of deep poverty, so they were more likely to be able to escape poverty in the future.

Families in poverty where the adults work full-time are less than half as likely to experience deep poverty than those with part-time work or no job. A reversal of this success story could have a profound effect; increasing poverty rates and deepening poverty for those already below the poverty line. So supporting employment, especially for those on the lowest incomes, must remain a key priority for Government as the country emerges from the lockdown restrictions that have caused the economy to contract so severely.

We also need to empower those in or at risk of poverty to increase their financial resilience. The SMC’s analysis shows that, before the crisis hit, nearly three in ten people in poverty lived in families that were behind paying the bills and seven in ten were in families where no-one saves. This means they did not have a buffer available to them when the pandemic struck and are therefore more likely to have fallen further into poverty.

However, it is not all bad news. The SMC’s analysis also shows that, after rising for the last three years, the poverty rate for both children and pensioners had plateaued before the crisis, and that, since the turn of the millennium, poverty levels haves fallen for lone-parent families.

In addition, there has been a drop in the poverty rate for families that include a disabled child over the last 10 years, and across all age groups there has been a fall in the proportion of people in poverty who are also in persistent poverty.

These success stories demonstrate that poverty can be tackled and reduced. But with millions of people still in poverty, we cannot be complacent.

The first step is to ensure that poverty is properly measured. This is essential if action is going to be taken to improve the lives of those currently living in, or at risk of falling into, poverty, and to ensure that those individuals, families, communities, and areas of the UK that have historically been left behind are supported to improve their situation.

After decades of damaging debate that has distracted focus away from the vital action needed to drive better outcomes for the most disadvantaged in society, a new consensus is needed so that policymakers and politicians can track progress and can be held to account.

I am delighted that the Government has committed to creating new experimental national statistics based on the SMC’s approach, as the first step towards adopting it as an official measure.

While it is entirely appropriate that this work was paused during the pandemic so the Government could focus on providing support to those individuals and families whose health and livelihoods have been impacted by the virus, the need to return to it is clear.

The next step is for a full Poverty Commission to be established to develop solutions based on this measurement data. We already know that poverty is more likely to be experienced by some families than others, and that the nature of that experience is incredibly varied.

The causes and implications of the various types of poverty are different, which means that the approach needed to tackle them will be different. As with the SMC, it will be important that the Poverty Commission has support from individuals and organisations across the political spectrum as well as from business, the charity sector, and those who are in poverty.

However, while the Poverty Commission will need to conduct further work to assess what really creates an enabling environment for different people, the existing data clearly shows that work is one of the most effective pathways out of poverty. Therefore, as the country emerges from the coronavirus pandemic, an employment- and skills-based recovery will be vital.

We must enable the smooth transition of those on low incomes who have been furloughed and need to increase their hours, to avoid them falling deeper into poverty. We need to re-open schools so that the education of the poorest is protected and to allow their parents to work the extra hours that could make all the difference.

And we need to ensure that schools are preparing students for the jobs that will be available in the future, equipping them with the skills they will need in a world of artificial intelligence and new digital technologies.

In addition, given half of those in poverty live in a family with a disabled person, we must increase support to help those with disabilities find full-time employment. The inescapable cost of housing, and especially private renting, is also one of the major factors contributing to poverty, so it is also vital that we make housing more affordable.

My hope is that the SMC’s poverty measurement framework can inform the creation of a comprehensive anti-poverty strategy. Where there are obstacles, we need to remove them, and where individuals can build their own pathway out of poverty, we need to ensure that they have the tools and support they need to do so.

This will require a partnership between those in poverty and policymakers, business leaders, and community builders across the UK. Together we can ensure that poverty is less prevalent in the UK after the coronavirus crisis than it was before and that as many people as possible can enjoy a life free of poverty in the future.

Andrew Gimson’s PMQs sketch: Johnson would rather be “Wrong but Wromantic” than “Right but Repulsive”

1 Jul

Boris Johnson borrowing the words of Oliver Cromwell! How promiscuous this Prime Minister is as a scavenger from history.

“I beseech the Right Honourable Gentleman just to think he might be mistaken,” Johnson told Ian Blackford, of the SNP, who had accused him of providing no new money for Scotland.

“I beseech you, in the bowels of Christ, think it possible you may be mistaken,” Cromwell wrote to the General Assembly of the Kirk of Scotland on 3rd August 1650.

But how typical of Johnson to plead for a politics of imprecision, whose practitioners, himself included, sometimes get things wrong. In that respect, he is as Cavalier as ever, content, in the immortal words of Sellars and Yeatman, to be “Wrong but Wromantic” rather than “Right but Repulsive”, as a Roundhead would be.

Sir Keir Starmer is a Roundhead. “Does the Prime Minister now regret being so flippant?” he asked today.

It would be wrong to describe Starmer as repulsive, but he is in danger of sounding humourless. To him falls the task of trying to recall the PM from Planet Freedom to Planet Fact.

Here is a necessary, indeed a moral task. No Leader of the Opposition can allow the PM’s rosy vision of the future to pass unchallenged.

Johnson looks ahead to a country where Covid-19 has been vanquished, prosperity rebounds, tax revenues cascade into the public coffers and the might of the state is employed with miraculous effect to raise up the left-behind, neglected, unloved voters who supported him last December.

Starmer was today the bearer of the bad news that Covid-19 has not yet been vanquished, stern measures have been taken too slowly to deal with the revival of the sickness in Leicester, and “the jobs many people had in January are not coming back”.

He has to continue with these stern warnings. They are his natural game. But might he one day discomfort Johnson by making a joke at Johnson’s expense?

Paul Bristow: The biggest challenge for our NHS may still lie ahead, but it’s also an opportunity

30 Jun

Paul Bristow is the MP for Peterborough and a member of the Commons’ Health and Social Care Select Committee.

Our NHS has done an excellent job looking after us during the Covid-19 crisis. But the biggest challenge for our NHS may be about to begin as the service deals with the backlog of delayed operations and treatments.

The lockdown began in order to protect our NHS. This was the early central message. The Government was concerned that hospitals would be overwhelmed as we saw in Italy and elsewhere at the start of the pandemic. This didn’t happen. Our NHS ramped up capacity as former NHS workers came back to serve, new hospitals were built, and a deal was struck with the independent sector. This push for increasing capacity within the system needs to continue.

We need a national effort backed by the Government PR machine – supported by the charisma and optimism of the Prime Minister – to back our NHS and clear the backlog. I have heard personal harrowing stories from NHS patients through my role on the Health and Social Care Select Committee.

Rob Martinez from Bracknell, who needed a double knee replacement, had his operation due in April cancelled. He told our committee that he had taken early retirement. I asked him if he would have continued to work if his operation had taken place – he confirmed he felt he could have worked for another 5 years. What was the most bitter blow is that he has been told there is ‘zero chance’ of his procedure taking place this year.

Another patient from Sevenoaks had her chemotherapy stopped. And while it has restarted, there remains huge concern that the number of patients receiving chemotherapy is far fewer than would be expected. Cancer Research UK estimates more than 20,000 patients did not get treatment because of the virus crisis.

Whilst official statistics have been paused, it is estimated almost two-thirds of Britons with common life-threatening conditions have had care cancelled. The NHS Confederation is saying that NHS waiting lists could rise to 10 million in the autumn, and take up to two years to clear. The Royal College of Surgery has called for a five-year strategy to tackle the waiting list situation.

This is now one of the Government’s central challenges.

We can do this. The NHS has shown its remarkable ability to cope, and yet again the British people have shown great resilience through this emergency. But it needs to be framed as a national effort with the Prime Minister and the Secretary of State personally leading this.

Those who have re-joined the NHS to help with the Covid-19 crisis need to be persuaded to stay. I appreciate staff will be tired, and those that have returned will need to be properly motivated. The appreciation that the public has shown to our NHS staff should help, but efforts will need to be made to make the NHS a better place to work and should be prioritised.

The Prime Minister had it right with the simple message about workforce at the General Election, promising to recruit and retain 50,000 nurses. We need to look with urgency at long-term recruitment issues. The NHS needs staff in almost every setting, as many begin to reach retirement age. According to the latest annual census from the UK Royal College of Radiologists, in 2020 approximately 200 doctors will qualify as radiology consultants – not enough to fill even half of the estimated 466 vacancies.

The Government needs to be alive to the challenges associated with the safety of NHS staff and patients. The need for PPE and new designed layouts will affect theatre capacity. Diagnostics, which underpin clinical activity in hospitals, and a backlog in MRI/CT scans, endoscopy and laboratory tests are also limiting factors.

Back in March, Matt Hancock was right to sign a deal with the independent sector. In peace time this would have been an incredibly courageous thing to do with those on the left gleefully pointing to proof of Tory privatisation. I hope that the Covid-19 emergency has dismissed the lazy assumption that the independent sector and the NHS cannot work in partnership.

A similar long-term deal agreement with independent providers to retain capacity will be crucial in the years ahead. They can help ramp up elective capacity, power through knee, hip and cataract procedures, and improve lives – and in the case of Mr Martinez may even allow him to return to work and generate more tax revenue to fund public services. It will also allow for cancer treatment and cardiology procedures to resume at pace and scale. With appropriate testing arrangements, these could quickly become a significant proportion of the ‘Covid-light’ units that are being regularly discussed as the means to reduce the elective backlog.

The NHS does so many things well. But few would claim – especially staff – it cannot become more productive. We have seen the NHS conduct GP appointments and other consultations through digital challenges. This has worked. It is also worth noting that much of this would have been impossible if it wasn’t for the visible presence of the NHS on our streets in the form of community pharmacies offering that face-to-face reassurance for many routine issues.

This obviously needs to continue, but it is only the beginning. Let’s start a conversation about how the NHS can change many care pathways to become more productive. We can accelerate the uptake of already established treatments, which can keep patients out of a secondary care setting or at least not in expensive hospital beds for days at a time, by the adoption of less invasive procedures.

Changing pathways to enable the adoption of technology has often meant local evidence needed to be established – this could take years and was often completely unnecessary. We can expediate the move to integrated care working, especially with regarded to initiatives such as shared waiting lists and flexibility in payment mechanisms. This is a chance to improve existing practice.

We can be optimistic and ambitious for the future of our NHS. So much goodwill has been garnered and our staff are more valued than ever. But it is also an opportunity for change. A national effort led by a transparent and upfront Government is what is required.