‘Mission’ is now a word deeply embedded in the vocabulary of policymakers and commentators across the country. According to the Institute for Government, there were no less than 52 events at the Labour party conference that included mission in their title. And many column inches since the election have been dedicated to the opportunities missions pose. But as we reach 100 days of the new government, are the missions laying the foundations for meaningful change?
The health mission sets out an ambition to secure “a fairer Britain where everyone lives well for longer.” Including health equity as a core focus for government is a positive, albeit, overdue response to a significant set of challenges: life expectancy in the UK ranks 25th in the OECD and is now stalling. Health Foundation analysis projects that an additional 2.5 million people will be living with major illness by 2040 and deep health inequalities between the most and least deprived areas of the country have widened.
As we said in July, it is encouraging that the government is framing health as something that requires long-term, cross-government action. Three months in, it is positive to see a strong central Mission Delivery Unit has been set up in the Cabinet Office and that a plethora of teams in departments are working on different aspects of the missions.
For the health mission at least, sensible conversations are happening about how success will be measured, with officials seeking external, expert input to inform the work. Ministers are also saying publicly they want challenge from outside government. We have been reassured that our fears that the health mission would become a de-facto NHS mission have not materialised: indeed, it seems the health mission board is placing a focus on the levers held by other departments to improve health.
However, it is too soon to say whether mission-based government represents a bold leap forward, or a repackaged set of cabinet committees and platitudes about cross-government working. The health mission is absorbing lots of time and attention within DHSC, but it is unclear where it features on the to-do list of officials and ministers in DfE, DWP or MHCLG. The missions all appear to be led by the “usual suspect” department with others engaged on specific issues, rather than embedded in the strategic vision of the mission.
Although the mission boards have met, little has been said publicly about their composition or top priorities. One of the intended distinguishing features of mission boards is a new way of governing “in partnership with business, trade unions, civil society, faith groups, and communities” but it remains to be seen whether membership will open up beyond government ministers, meaning there is a risk that mission boards become replicas of existing cabinet committees. Furthermore, there appear to be no immediate plans for an independent body to provide expertise and accountability for the health mission, as the Climate Change Committee does for net zero (also a government mission). If government is essentially marking its own homework, there is a risk that it will fail to maintain the focus and momentum to deliver this long-term, complex agenda.
The missions all appear to be led by the “usual suspect” department with others engaged on specific issues, rather than embedded in the strategic vision of the mission.
So after a positive start, the challenge now is to use the mission boards as the key mechanism through which government delivers its commitments and to build in external scrutiny and accountability.
Fixing the foundations
Taking a step further back, missions-based government will need to address some of the underpinning structures and ways that government does business. To steal a phrase from the prime minister, government need to “fix the foundations” of how it works both internally and across the system if the health mission, or any of the missions, are really going to change anything.
Firstly, missions will only work if there is a change in mindset among officials and ministers towards seeing their work as a collective endeavour, rather than a quest to deliver a single departmental agenda. This will require a shift in culture, incentives and performance management – with outward looking leadership from ministers and permanent secretaries – and crucially, a greater focus on the impact of major policy decisions on health.
Secondly, it is vital that HMT think imaginatively about how to support rather than stifle missions-based working. As we’ve argued in our work with Demos, the Treasury also has a key role in enabling a different approach to prevention. Currently fiscal frameworks and short-termism give strong incentives to disinvest in preventative services. We are working with Demos to explore a plan for introducing a new category of spend to classify and ring fence prevention spending. The chancellor’s comments at party conference about judging the economic impact of health spend are welcome and are hopefully the beginning of a more concerted approach to judge both the contribution health makes to other agendas and how other agendas can both help and hinder health.
This all points to another failing foundation: the ongoing short termism in government thinking. This is a perennial problem for government but Labour has shown previously it can think long term, for example in the Health Inequalities Strategy of 2000 to 2010.
Finally, the system beyond Whitehall – not least local and regional government – must be supported to take action. All eyes are on the budget to see what materialises from Labour’s promises of multi-year settlements for local government and whether, as IFS have called for, updating funding formula is prioritised to ensure a stronger relationship between funding and need. Without significant progress here, mission delivery at place level is going to be severely compromised.
Missions remain exciting to policy geeks and there are positive signs that they do offer an opportunity to do things differently. The next 100 days will be crucial to ensure the foundations for their success are there and that mission development starts to shift to mission action.
Katherine Merrifield is assistant director for healthy lives at the the Health Foundation