The British National Cabinet

Letter from the Committee Director

Dear Delegates,

Hello and welcome to Yale Model Government Europe 2017! I am Muriel, and I am very excited to serve as your Committee Director for the Cabinet of the United Kingdom and also as the Under-Secretary-General of Branding. I look forward to making your overall YMGE experience as enjoyable and as rewarding as possible. During the conference, I hope to facilitate engaging debate, encourage innovative solutions, and examine some of the most pressing issues facing the United Kingdom, Europe, and the world today.

I am a sophomore at Yale University from Singapore and Boston, Massachusetts. I have also lived in Shanghai, China and in Concord, New Hampshire. I have visited Budapest once before but only as a tourist. While I have not decided on a major yet, I hope to focus on History, Global Affairs or Political Science. As a member of the Yale International Relations Association (YIRA), I was also involved with SCSY, YMUN China, and YMUN. Outside of YIRA, I am involved with Yale Children’s Theatre and Elm City Echo, a periodical published by New Haven’s homeless community. I also work in the Admissions Office as a Recruitment Coordinator. In my free time, I like reading, catching up on TV shows and movies, and creative writing. I am not much of an outdoors person, so I prefer activities that keep me in an air-conditioned or heated room.

As your Director, I am more than happy to help you in any way I can. If you have any questions or concerns about this topic guide or YMGE in general, please feel free to contact me at muriel.wang@yale.edu. I will get back to you as soon as I can.

I look forward to seeing you all in Budapest!

Sincerely,

Muriel Wang
muriel.wang@yale.edu

Ever since the 17th century, the conception of a national cabinet has existed (back then, under a Royal Command) in the United Kingdom. In fact, the system of government with a cabinet originated in Great Britain. Developed from the Privy Council, a body which used to be the British sovereign’s most important decision-making collective, the cabinet slowly came to being after the Privy Council was deemed too large and unwieldy to be effective. The cabinet then became a smaller subset of the Privy Council after its decline.

The monarchs of Great Britain played a huge role in the gradual growth and formation of the cabinet. George I, in power from 1714-27, spoke little English and became increasingly distant from the workings of the monarch’s council, and stopped attending most meetings in 1717. Therefore, the cabinet became centred around the prime minister, an office that came into being under the leaderships of Sir Robert Walpole and Sir William Pitt. In 1832, the Reform Bill was passed with the goal of expanding the electorate and specifically benefitting the House of Commons. As a result of the Reform Bill, the cabinet started to include members from the majority party in the House of Commons. The cabinet ministers were therefore further responsible to the House of Commons for their behavior while in office. Since the House of Commons became so pertinent to the workings of the cabinet, cabinet ministers realized that the way to stay in power was to gain the support of a majority in the Commons. In order to gain such support, politicians started forming united political parties, developing alongside the cabinet government.

Today in the UK, under the Westminster system, the cabinet is known to have de facto executive power. We see a national cabinet composed of the Prime Minister and 15 to 25 cabinet ministers, who are commonly deemed the most senior of government ministers. There has never been a set number of ministers in the cabinet, since the Prime Minister has the right to combine various governmental departments or create new posts. The Prime Minister appoints the ministers of the cabinet, usually within hours or a few days of an election win. Working to support the Prime Minister in a myriad of capacities, the cabinet ensures that the government runs effectively, while acting as the corporate headquarters in partnership with HM Treasury. The cabinet works to discuss different points of view and arguments in relation to the topic at hand, comes to a decision that is supported by its majority and makes government policy when supported by the House of Commons. As a result, all decisions made in this cabinet must have collective responsibility. In other words, all cabinet ministers are expected to lend support to and defend all policies publicly. In fact, if the minister does not feel comfortable with defending a cabinet policy, they may resign. The UK works today as a Parliamentary democracy. As of this writing (August of 2017), Prime Minister Theresa May of the Conservative party called a snap general election that resulted in a hung parliament. Her new, reshuffled cabinet is now under a lot of scrutiny.

The National Health Service (NHS) of the UK was launched in 1948. In its over 70 year history, it has become a hot-button issue for campaigning politicians, a source of grievance for countless citizens, and an idealized healthcare model emulated by some countries around the world. Borne out of the ideal that everyone, no matter how wealthy, should have access to good healthcare, the NHS is free for almost all points of use for UK residents. According to their website, the NHS in England serves around 1 million patients every 36 hours, and works to cover everything from routine screenings like the NHS Health Check to more intensive treatments for long-term conditions. It is also important to note that there are four National Health Services, one in England, and the others in Northern Ireland, Scotland, and Wales. Each of the UK’s four nations is responsible for their own NHS.

Established by the Labour Party after World War II, the NHS prides itself on its core values, striving to provide healthcare that meets the needs of everyone, that is free at the point of delivery, and that is based on clinical need instead of one’s ability to pay. Before the establishment of the NHS, however, healthcare in the UK was definitely not free. The poorest of society were often punished the most, as healthcare was a privilege for society’s wealthy rather than a right accessed by and created for all. In 1909, the Minority Report of the Royal Commission on the Poor Law was one of the first instances of a call for a “unified medical service.” Although the Poor Law shifted some perceptions in society, it did not make a big impact on ameliorating healthcare amongst the British. In 1911, the National Health Insurance Act was passed, but did not insure the families of workers.

It was not until 1942, with the publishing of the Beveridge Report, that the National Health Service was even conceptualized. The Beveridge Report, or the Social Insurance and Allied Services, worked to develop a type of welfare state of governance for the United Kingdom. A main contributor of the document and influential economist, William Beveridge, described Britain has having five giant societal evils, that of squalor, ignorance, want, idleness, and disease. He then developed a proposed system of societal welfare to address these issues, one of which focused on “comprehensive health and rehabilitation services for prevention and cure of disease.”

While numerous politicians attempted to better healthcare and welfare for the poor, it was Clement Attlee’s Labour Party that appointed a Health Minister in 1945, who built the foundation for what we know as the NHS today. As a result, we now have in British society a National Health Service that is often called the institution which “more than any other unites our nation.” It even had a prominent spot in representing the UK during the 2012 Summer Olympics in London!

In order to determine the National Cabinet’s role in affecting changes within the NHS, one must understand the stakeholders keeping the NHS afloat. The NHS, in line with the social reforms planned by the Labour Party after the Second World War, is 98.8% funded by the contributions from general taxation and National Insurance. A very small part of its funding comes from patient charges. Furthermore, the NHS, although an independent body separate from the government, is related closely to the Department of Health in its functioning. The Department of Health is largely responsible for providing strategic leadership, and the allocation of funding in relation to most health matters. Therefore, the NHS must still work very closely with the ministerial department and its 23 agencies and public bodies.

Over its long history, the NHS has been reformed many times for different reasons and to achieve vastly different purposes. Since the Beveridge Report, the NHS has been affected by a slew of different policies and pieces of legislation. In the 1990s, for example, the NHS Community Care Act was passed, allowing most authorities in the health industry to manage their own budgets. They may also start buying healthcare from hospitals and other organizations. NHS trusts were also created to help authorize independent organizations as providers of healthcare. Furthermore, in 1998, NHS started the NHS Direct service. NHS Direct was an e-health service, the largest in the world, that handed half a million calls a month. In addition to the already-revolutionary NHS walk-in centres, NHS Direct made healthcare more convenient for all families in the UK. It is important to note that these reforms are not made to be permanent solutions, and are instead expected to adapt to the times. NHS Direct, for example, closed in 2014 to make way for NHS 111, a non-emergency number for all people to access local healthcare services.

The 2000s were a huge time for NHS reform, especially with the passing of the NHS Plan. The NHS Plan is known as the biggest transformation to British healthcare since 1948. Some problems the UK faced before the NHS Plan include vast geographical inequalities in healthcare coverage, limitations of patient choice, and accommodations made for the elderly who are susceptible to more health problems. The NHS Plan set out to eliminate and address most of these concerns, in order to produce health services that were more inclusive. It also sought to work in the intersection between healthcare and social care, taking into consideration the myriad of problems citizens face due to longstanding societal issues.

A decade and a few years later, the Health & Social Care Act of 2012 was enacted. First published on June 15. 2015, and having taken effect on April 1, 2013, this piece of legislation transformed the funding of the NHS. Prior to the Act, the Department of Health was in charge of pricing. Now, NHS England and NHS Improvement have the common responsibility of managing the budget. In fact, in 2015, the NHS itself was managing £101.3 billion of the £116.4 billion overall budget. In addition, clinicians are now placed at the centre of commissioning, so healthcare providers feel more liberated to make their own choices in provisioning NHS resources and services.

The Health & Social Care Act attempts fundamentally to address the oft-repeated criticisms that the NHS is unsustainable. It addresses this problem by promoting more accountability towards patients, increasing choice and competition by allowing competition from private healthcare providers, and building the leadership skills of general practitioners (GPs).

The NHS is constantly adapting to its new environment and changing to better suit its patients. How will the role of the NHS change under the UK’s departure from the European Union, also known as Brexit? How will the cabinet act in order to better healthcare provisions for its citizens? Can the NHS achieve its initial goals on its founding to provide access to healthcare for all citizens, regardless of wealth?

Summary of Topic History:

The NHS was borne out of the belief that UK residents, no matter how wealthy, should have access to good healthcare

The NHS was established by the Labour Party after WWII

The Poor Law also worked to impact healthcare for those who could not afford it

The Beveridge Report made an impact on social reforms and in promoting the values of the NHS

The NHS is currently funded mostly by taxpayers

The NHS Plan and the Health & Social Care Act are modern pieces of legislation that impacted the workings of healthcare provision

How can we reform the NHS to better work around new issues faced by the UK?

As mentioned before, the NHS is often discussed in the UK cabinet. Services are deteriorating, some complain. Others claim that it has been poisoned by Brexit. Some still say it’s the best healthcare system More specifically, the Commonwealth Fund, a Washington-based foundation “which is respected around the world for its analysis of the performance of different countries’ health systems,” through examination and research from patients, doctors, and the WHO, ranks the NHS as best healthcare service overall among 11 developed countries, since it spends the second-lowest amount on healthcare and has the highest quality of access and efficiency.

While it is true that the NHS came on top of a Best Healthcare System ranking of 11 developed countries in 2014 by the Commonwealth Fund, some argue that it is complacent, useless, and even stupid to believe that its problems can be overlooked. The current situation of the NHS is such that those benefitting from its policies rejoice, while those who suffer from its many drawbacks spread harsh words of its deficiencies. According to a leading health think tank, the King’s Fund review, NHS services in England have been deteriorating steadily, at rates not seen since the early ‘90s. Amongst some of the grievances, inordinately long waiting times normally get the most limelight. In fact, the King’s Fund specifies that “waiting times for Accident and Emergency (A&E), cancer care and routine operations had all started getting worse, while deficits [are] growing.” It also states that the drops in performance have not been seen for 20 years. It is also important to acknowledge, however, that the terrible financial climate is the past decade must be taken into account when calculating growing deficits.

In this topic guide, we will examine a few extremely crucial sub topics within the larger, overarching topic of NHS reform that will point at the root of some, but definitely not all, of the NHS’s problems. Through examining these separate sub topics, we hope to narrow the problem into more palatable issues so as to better tackle the idea of NHS reform more comprehensively. Alternatively, should we give up on NHS reform and scrap the Service completely? The Labour party promises to repeal the Health and Social Care Act of 2012 and wants to “halt and review” sustainability and transformation plans (STPs). Should public health be in the hands of local government?

When examining the current situation of the NHS, it is important to know that the subtopics will attempt to pinpoint several criticisms of the system. These will be the hot-button issues to be tackled with nuance and varying perspectives in order to even begin debate on NHS reform.

Brexit Implications

In June of 2016, the United Kingdom left the European Union after a referendum widely referred to as Brexit. In what is now called by some to be the “biggest decision faced by Britons in a generation,” the choice to leave the EU has not been easy on institutions like the National Health Service. Critics have stated that the service itself “seems to be on life support and stumbling towards a final and fatal collapse.” In fact, the promise of 350 million pounds to the NHS every week made by Brexit campaigners has not been fulfilled. Furthermore, the NHS itself profited largely on the migration of other European staff. The Department of Health has even stated that if the migration of nurses from non-UK EU countries stopped completely, the UK could have a shortage of 20,000 nurses by 2025.

On a separate note, the European Medicine Agency (EMA), which is a highly crucial EU regulatory body, is actually based in London. Due to the Maastricht Treaty, London is home to the EMA and is therefore the headquarters for ensuring that all medicines in the EU are safe. These medicines must also be effective, tested, and of a certain quality to be distributed to citizens of the EU. Since the UK and the EMA are so closely tied in relationship, Brexit has raised a lot of questions about the future of such an important agency to the functioning of the health service the EU. In fact, the EMA itself is associated with about 1300 Qualified Persons for Pharmacovigilance (QPPVs), and all sorts of various researchers, pharmaceutical companies, and subcontractors who chose to settle in London due to its status as the EMA headquarters. Now, with the evident move from London to a new host country, the EMA is favored to be headquartered in Amsterdam. Nineteen countries have actually submitted official applications to host the EMA as soon as Brexit is finalized in March of 2019. The winner will be decided in November 2017.

The EU has also stated that the UK must foot the bill for the relocation of of the EMA. In fact, making Britain pay is “part of the negotiations on the withdrawal agreement.” The UK actually has a 520 million pound bill to pay for having to move the EMA. Critics of the move are very vocal, stating that it is “crazy” to have to pay large amounts of money only to lose highly skilled workers and research capacity in the UK.

The UK is currently in a new state of limbo, even with the European Free Trade Association arrangement on the table, which is a future that will soften the blow of Brexit on every fact of the NHS. However, the UK is tasked with the important problem of 47% of its highly-skilled EU workers trying to leave the UK in the next five years. This could be twenty-thousand highly skilled European nurses leaving the country.

Summary of key points:

Brexit may cause a lot of highly skilled hospital workers to leave.

Brexit results in a costly move of the EMA and other important healthcare agencies out of London.

The NHS is promised at least 350 million pounds a week due to Brexit. Is this possible?

The Question of Privatisation

An often-debated reform is the potential privatisation of the NHS. In fact, some of the evidence we have today points at the fact that NHS is slowly privatising already. Before Brexit, when the UK was still a member of the EU, the UK had to ensure that all of its domestic policies complied with the EU competition law. The European competition law works within the EU to manage and regulate conduct that may be deemed anti-competitive. Although the EU mostly stayed out of interfering with NHS workings, there was a huge interest in public health and ensuring that public services were also subject to the competition law.

After Brexit, the UK is no longer subject to the competition law, but some say that it must still work to promote Conservative leaders’ wish to encourage the involvement of the private sector in the NHS. For the past few decades, the British government has gained an interest in diversifying the way health services are allocated. The government has also initiated yearlong conversations on how best to allow multiple providers to enter the healthcare market.

In some ways, the privatization of healthcare may not be in the best interests of patients. Some believe that allowing private healthcare providers to compete with public ones can lead to greater expense. We see this trend in many different sectors of society, most prominently with transportation, in which public transport is often privatized. Furthermore, privatized healthcare could lead to lower quality of healthcare provision. This is due in part to the fact that private providers look to maximize their own profits. Good healthcare is also harder to obtain for patients who have extremely rare and serious conditions. Logically, private companies not only work to maximize their profits, but also hope to make profits in a quicker manner. By focusing research and allocating resources to common diseases, these healthcare providers may make more money, but do not do any favors for patients with rare diseases.

Evidently, the privatization of healthcare can also benefit patients and society. As mentioned, competition is crucial to ensure pricing is fair, and to drive research. In the fight for customers and patients, these healthcare providers may improve efficiency in order to become the private provider most venerated, trusted, and respected by the people.

The evidence currently shows that healthcare politics are at the helm of governmental debate. Owen Smith, a Labour Leadership hopeful, points to a “secret Tory plan” that aims to privatize the NHS. He claims that the the NHS is becoming increasingly privatized, warning of the NHS budget going to firms like Virgin Care, Care UK, and Bupa. Another Labour claim is that key areas of NHS care are actually going to the private sector, as general practice, community services, and mental healthcare seem to be increasingly privatized.

Summary of key points:

The NHS is already slowly privatizing

There are pros and cons to such a course of action, with impacts of efficiency, quality, and provision of healthcare

The privatization of the NHS remains a hot topic for both the Labour and Tory party

NHS Cuts

It’s currently estimated that if the UK does not make any changes, the NHS will face a 30 billion pound funding gap by 2020. This is due in part to the current financial crisis but also due to the general rising costs of services, energy, and supplies. With our frequent breakthroughs in new technology, new medical supplies, and general new innovations, the world is facing the need to invest more and more into healthcare. The UK, no doubt, is seeing this tension between the higher number of patients, the rising costs of serving them, and the need to cut back on funding for the NHS due to financial crisis.

Depending on the party in power, the rise in NHS spending has fluctuated. The average annual rise is approximately 4%. During the years when Labour was in power under Tony Blair or Gordon Brown, this percentage was actually closer to 7%.

Now, under Theresa May, the UK is seeing even more NHS cuts. The Labour Party leaders frequently accuse May of “underfunding” the NHS, meaning “services cut and rationed, patients forced to wait longer for treatment, and a postcode lottery where healthcare varies depending on where [one] lives.” Furthermore, these new cuts mean that patients may actually be denied treatment, an accusation not taken lightly due to the original goal of the NHS to serve all regardless of background. The Accident & Emergency department and maternity units are also at risk of receiving unprecedented cuts in London. Important internal NHS documents also show that doctors in some boroughs have less to spend on drugs. In addition, fewer patients are referred to the hospitals.

There is no doubt as to who is hit hardest by these cuts: the disabled, the poor, and those in dire need of treatment, especially in regions like Straffordshire, Bristol, and even Southwest London.

With these cuts in place, hospital units could be either downgraded or shut down altogether. These actions are completed under the guise of “centralisation of key services.” Therefore, smaller hospitals may actually disappear in the next few years. Some other key services cut include:

- A two million pound cut to financial support for people with long-term, severe medical problems and disabilities (including brain damage)

- Less money into the Better Care Fund, which is supposed to support hospitals by providing better social care support for older people

- Job losses in order to lower “admin costs”

Summary of key points:

NHS cuts are a result of tightening budgets, economic downturns, increasing technological demand, and an aging population

These cuts imply that the NHS may not function as well as it is meant to, depriving some of crucial medical care

The Cabinet needs to find a way to restructure the budget in order to spend more efficiently and save key infrastructure in the UK healthcare system.

Questions to Consider:

How can the Cabinet increase the number of homegrown nurses?

How can the impact of Brexit be lessened so the EMA and other important agencies stay in the UK?

How will the relationship between the UK and other EU countries work now in terms of healthcare?

What is the best way to determine funding for the NHS?

Why are the NHS’s founding principles still relevant today?

What can the UK learn from other countries’ systems of healthcare?

What will the privatization of the NHS look like? Do you believe this is the way to go?

Labour Party

The Labour Party, led currently by Jeremy Corbyn, is the UK’s centre-left political party. To learn more about their position on the NHS, feel free to check out their website: http://www.labour.org.uk/index.php/nhs-campaign.

As the proud founders of the NHS, the Labour Party frequently tries to remind the British government of the NHS’s founding principles. Commonly, it undermines the Conservative (Tory) Party’s agendas by accusing those politicians of underfunding the NHS.

Conservative Party

The Conservative Party, led currently by Theresa May, has stated that a goal is to increase NHS spending by 8 billion pounds in the next five years in real terms. The Party’s concrete aims are the focus on training more British staff in order to place less reliance on foreign (read: EU) workers. They also plan on focusing on the technology the NHS needs to deliver care efficiently, in addition to recruiting 10,000 mental health professionals. Overall, the Conservative manifesto hopes to hold the NHS accountable for their work.

Explore NHS reforms

https://www.theguardian.com/society/2011/apr/20/nhs-reforms-key-issues

This is an older article, from 2011, that demonstrates some of the biggest controversies during the NHS reform debate. There are four key themes to NHS reform, and this article attempts to briefly summarize the debate.

NHS’s challenges?

https://www.myhealth.london.nhs.uk/help/nhs-today

Read this page for the NHS’s own opinions on what its biggest challenges are. As an agency that tries to improve its healthcare provision, MyHealthLondon is a great place to start in understanding how people who work for the NHS understand the issue.

Negative view of the NHS

http://www.bbc.com/news/health-38887694

To understand the main criticisms against the NHS, one must explore the academic arguments of the NHS’s downfalls. This BBC article explains the problems of the NHS in visual terms.

Read the News!

https://www.nhs.uk/news/

The NHS has its own news section that attempts to set the record straight. Browse through their website for their take on some of the biggest healthcare headlines.

The Guardian

https://www.theguardian.com/society/nhs

The Guardian has dedicated an entire tab to the NHS, emphasizing arguments on both sides in order to get to the truth of the healthcare provider. It is a treasure trove of op-eds, reporting, and general well-rounded discussion.