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The role of emotion in health communication
The role of emotion in health communication

Posts Tagged ‘WA Investor Services’

IVF – what to expect when you’re expecting returns

A recent World Health Organisation report finds that about one in six people worldwide experiences infertility. Unsurprising, then, that this year would-be parents around the world will spend an estimated £12.8bn on fertility treatments, a figure growing at an annual rate of 10.3%. The UK IVF market – valued at around £420 million in 2018 – is expected to reach £760 million by 2026.

WHO officials highlight that IVF remains “underfunded and inaccessible to many due to high costs, social stigma and limited availability”. In the UK, IVF is provided through a mix of NHS and private services, and regulated through the Human Fertilisation and Embryology Act, passed in 1990. The Act has been updated only once, in 2008, despite the sector having witnessed scientific breakthroughs and an accompanying shift in public perception in the time since. Both factors have contributed to a significant growth in demand. As attitudes and access to IVF have evolved, sector stakeholders have started to highlight issues: regional variations in NHS funding, poor regulation of treatment ‘add-ons’ and perceived profiteering.

Although the National Institute for Health and Care Excellence (NICE) recommends three cycles of IVF for women under 40, some Integrated Care Boards offer only one cycle, or only offer NHS-funded IVF in exceptional circumstances. In the absence of national standardisation, and at a time of squeezed public sector budgets, the recent years have seen a steady decline in the number of IVF cycles funded by the NHS. Data shows that NHS-funded cycles in England fell from 40% in 2014 to 32% in 2019. In Wales, they fell from 42% to 39% over the same period, and in Northern Ireland they fell from 50% to 34%. Scotland is the only devolved nation to have seen an increase in the proportion of IVF cycles funded by the NHS, up from 58% to 62%.

Reflecting these developments, IVF has attracted media and political interest, with MPs from across the political spectrum becoming more vocal about the issues in the sector.

Launched in Summer 2022, the Government’s Women’s Health Strategy acknowledged the need for action and announced NICE would be updating its guidelines on fertility, with changes expected to be published in November 2024. The strategy removed the requirements for same-sex female couples to self-fund fertility treatment before becoming eligible for NHS-funded care and committed to exploring the possibility of publishing data nationally on IVF provision and availability. Several Labour MPs, including senior Shadow Cabinet members, have criticised the strategy for failing to get to the heart of the problem, claiming that increased transparency around available funding doesn’t do anything in improving provision or tackling the postcode lottery for fertility services.

According to HFEA, in 2019 the average birth rate per embryo transferred (IVF attempt success rate) was 24%. It comes as no shock that would-be parents have increasingly been opting for add-on treatments in hopes of improving their chances of conception. Add-on procedures are optional extras that are offered by clinics on top of normal fertility treatments. There is currently little direct evidence that add-ons, which can add up to £2,500 to the cost of each attempt, improve the chances of success. In the absence of available evidence, and the growth in demand for add-ons, in June 2021 the Competition and Markets Authority issued guidance for fertility clinics to ensure they don’t mis-sell add on treatments. Still, HFEA’s 2022 National Patient Survey found only 46% of people who used add-on treatments felt their clinic has clearly explained how likely the add-on was to increase their chance of conceiving. This debate is part of the reason why HFEA has been calling for reforms to the Human Fertilisation and Embryology Act for years.

It was only earlier this year that the Government asked the independent fertility regulator to submit reform recommendations for consideration. Now HFEA is seeking additional powers to enforce standards, including the ability to introduce economic sanctions on non-compliant providers. The lack of control over fertility treatment add-ons by HFEA have enhanced the criticism of the poor regulation and fuelled the ‘profiteering’ debate.

Given the mounting scrutiny, increasing size of the sector and the fact that the Women’s Health Strategy had already set out that government would consider changes to regulatory powers to cover fertility treatment ‘add-ons’, it is likely HFEA’s recommendations will be accepted. Even if parliamentary time is squeezed, and the Government doesn’t make progress ahead of a General Election expected in late 2024, women’s health will be high on Labour’s agenda should it form the next government.

Labour MPs have been vocal on a number of women’s health issues, with menopause awareness in the workplace being the most recent example. And with the Shadow Secretary of State for Women and Equalities, Anneliese Dodds, calling for a “national conversation” on women’s health and wellbeing, it is safe to assume Labour would take a more interventionist approach in government.

With 3.5 million people struggling to conceive in the UK, and the proportion of IVF cycles provided by the NHS steadily declining, private provision of IVF remains a growth industry. Considering the WHO’s recent findings and calls for better policies and public financing, the regulatory landscape is likely to tighten, so those looking to invest in the sector will need to keep an eye on both regulatory reform and updates to NICE fertility guidelines. The policy agenda of a potential Labour government, which is more likely to scrutinise profit-making delivery models in the health space, should also be a key consideration.

However, tighter regulation needn’t be discouraging, especially if it is followed up with better public financing. As we have seen in other sectors, if done well it is likely to build confidence and present growth opportunities for high quality providers committed to doing their best for patients. And that should motivate investors to drive the innovation that will deliver better outcomes for patients – and reward all expecting stakeholders in the long run.

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Mission Zero: Chris Skidmore’s independent review and America’s Inflation Reduction Act

America’s Inflation Reduction Act (IRA) is one of several major pieces of legislation underpinning the bold new economic agenda of the Biden administration. Its name is misleading as it will have little impact on US inflation but is the combination of a domestic industrial policy and an ambitious strategy for net zero, offering $369 billion in investment and tax breaks over the next ten years.

Across the pond, the IRA has been sharply criticised by UK and European politicians and policy wonks due to strict “made in USA” rules that would disqualify European based companies from generous tax breaks and lucrative investment opportunities. UK Trade Secretary, Kemi Badenoch described the legislation as protectionist, stating “it is onshoring in a way that could actually create problems with the supply chains for everybody else.” It risks incentivising companies to re-locate to North America and diverting investment away from the UK and Europe.

Or to quote the Chair of the UK’s Energy Digitalisation Taskforce, Laura Sandys CBE, “the IRA is a game changer… big investors are saying ‘US first, Europe second, Asia third and if you’ve got any spare peanuts at the end of it maybe you can look at the UK.’”

As the US Treasury and Department of Energy are expected to publish IRA guidance in March, UK and EU energy ministers are haggling with their American counterparts to secure concessions and minimise the risks to their respective energy markets and economies. For UK investors, it also prompts questions about the state of play closer to home, with the Conservative Government’s approach putting the UK at risk of falling behind in the global race to maximise the growth potential arising from net zero.

Green leadership in the UK

To rephrase an idiom, the Government’s approach could be described as ‘all wind but no power’. Whilst the UK’s net zero ambitions are well rehearsed by politicians and have been written into law, the policies and funding fail to match the rhetoric. This has created a vacuum which the Labour Party is filling with its Green Prosperity Plan and the promise of £28 billion annually for capital spending on projects designed to tackle climate change.

The Government will need to move quickly for two reasons. Firstly, the High Court ruled in July 2022 that ministers need to explain and substantiate how they plan to deliver on the Government’s Net Zero target by April 2023 following a successful judicial review by climate change campaign groups.

The Court-ordered report is likely to be wrapped up with Government’s response to the independent review of net zero, published in January 2023 and chaired by former energy minister, Chris Skidmore OBE. Skidmore’s 340-page review contains 129 policy recommendations that present the economic case for net zero as “the growth opportunity of the 21st century”.

Secondly, as highlighted by Skidmore’s review, many of the UK’s competitor economies have already made bold and ambitious interventions. Both the USA’s IRA and the EU’s €250 billion Green Deal Industrial Plan provide significant funding and the long-term policy certainty that is mission critical to securing private sector investment in their respective economies. If UK investors are left out in the cold, the UK risks not only losing out on new opportunities, but also current economic activity moving away.

What next for investors?

UK investors can expect the Government to act imminently. Ministers are acutely aware of the competition concerns arising from the USA’s IRA and will want to exploit the UK’s pre-existing market strengths. While the UK cannot compete with the sheer industrial capacity of North America, it is likely ministers will seek to capitalise on the UK’s strong science base and highly specialised expertise in both clean technologies and green finance.

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Dairy farming: private equity’s next cash cow?

You only need start an episode of Clarkson’s Farm and you’ll soon pick up some of the immense challenges facing farmers across rural Britain today – longstanding issues with supply, distribution and pricing have been propelled by the pandemic, complicated by Brexit, accelerated by the war in Ukraine, and intensified by the cost-of-living crisis. Nevertheless, there are significant and exciting opportunities for growth which make UK agriculture an attractive prospect for investors.

According to the 2022 Agrifoodtech Investor Report, $57.1 billion was invested in agrifoodtech companies in 2021, an increase of 85% on the previous year. 2021 also saw the UK’s highest ever deal flow with UK-based deals reaching £1.3 billion in value, the highest since data has been collected and up from £1.1 billion of investment in 2020. The UK sits 5th in the global ranking of deals by country, just behind Germany, India, China and the USA, though the UK government’s ambition is to be a world leader in this space. While investment in upstream technologies like on-farm tech, tools and services remains high at around $20m, there is a shift beginning to take place with interest now moving towards farm management software, indoor farming, ag-biotech (such as gene editing), and e-grocery. Going forward, agri-tech innovations will be crucial in helping the sector manage labour shortages, energy prices and food security. Private equity investment will be crucial in helping the sector get there.

Those close to the industry, both on the farms and holding the purse strings, are particularly excited about the dairy industry. While this farming discipline is not without challenges of its own (fluctuating prices, rising costs, environmental footprint and bovine TB to name but a few), the opportunities for growth are vast. Advances in genomics and precision livestock farming have underpinned recent productivity and efficiency gains across the dairy sector, supporting the transition towards net zero. For example, the application of precision livestock farming using animal behaviour monitoring via diagnostics and sensors have helped provide valuable data insights into the economic and welfare challenges affecting dairy farmers such as lameness, mastitis, fertility and wellbeing. Precision livestock farming systems are being trialed across farms in the UK, US and China and access to rapidly expanding markets in Asia is being supported by the UK government.

The demand for British dairy products remains high, and not just in the UK. The UK exports almost £2 billion of dairy products to more than 135 countries across Europe, North America, Asia and the Middle East. As a result, the UK dairy sector is well placed to capitalise on the government’s ‘Made in the UK, Sold to the World’ campaign as UK farmers are some of the most environmentally progressive and efficient in the world. One study assessed the dairy consumption of 90 dairy-importing countries with a population of nearly 5 billion. It found that between 2011 and 2019, dairy consumption in those countries increased from 258 billion kg to 304 billion kg – an increase broadly equivalent to two years’ worth of the total milk production volume of New Zealand. Countries such as these are expected to see an increase in demand over the next decade, currently projected at 5.6% per year from 2019 to 2025. It is unlikely that they will be able to meet these demands locally.

Alongside this, recent reports also suggest that the EU dairy industry is in decline. Production is expected to fall by as much as 6.3% in Europe over the next 6 years largely because of the implementation of the EU’s Green Deal and resulting updates to the Common Agricultural Policy. This represents a significant opportunity for UK dairy farmers, with dairy export markets typically more profitable than domestic ones. As a result, many dairy processors are undertaking investment to allow them to access growth markets overseas.

In 2022 the National Farmers’ Union expended considerable effort pushing forward a dairy export strategy with the ambition of doubling UK dairy exports in the next 10 years. Working closely with the Department for Business and Trade, the NFU continues to see this as a priority for 2023. Over the coming year we can expect the sector to push for trade and regulatory policy that supports the industry to compete at a global level. It will also court investors to inject vital funds into dairy businesses to maximise the industry’s innovation and resilience; the investors who do, look set for a good yield.

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A trillion dollar lift off in the commercial race for space

As recession looms over the UK economy, investors will be asking: what sectors will be resilient against the headwinds of economic downturn? Conventional wisdom points to those companies, industries, products, or services that we cannot live without, such as healthcare, consumer staples and utilities. But perhaps surprisingly, the space industry is also tipped to be largely recession proof.

Whilst the media grabbing headlines of space tourism or a failed rocket launch often portray an industry characterised by mystique and adventure, the less glamorous technologies that make modern space exploration and exploitation possible will prove fundamental to modern living, and indeed statecraft. From providing location data to mapping weather patterns, natural disaster prevention to protecting national security, everyday life and traditional industries are likely to be the primary beneficiaries of space enabled transformational change.

State-driven endeavours into outer space were a key battle ground of the Cold War. The commercial battle, dubbed ‘New Space’, has become a new field of competition for nations and private companies alike, with the battle for supremacy having rumbled along for well over a decade. Governments around the world are racing to secure their foothold in this evolving domain, recognising the sector’s economic and strategic potential. Or to quote from Policy Exchange’s Space Unit, the first of its kind at any UK think tank, “UK commercial space is not just another commercial market that should be left to the vagaries of a global market, but is a strategic sector of national security interest and importance that provides critically needed technologies and services”.

Slice of the economic pie

At present, the UK space industry generates £16.5 billion annually, more than a trebling since 2000, and space technologies now underpin £360 billion per year of UK economic activity. Globally, the space market is expected to increase from $339billion (2016) to $2.7 trillion by 2045, a figure comparable to the economic might of the oil industry today, which represents nearly 4% of the global economy. The UK economy is well placed to benefit from this future trillion-dollar industry with a 5.1% foothold already established in the global market. However, if the UK wants a large slice of this lucrative pie, it will need to take a leading role in shaping the development of the global space industry, continue to expand and build new spaceports, as well as attract companies to locate in the UK.

Opportunities for investors

Investors have witnessed an inflection point within the space market. Venture capital continues to back start-ups at record levels year on year, creating a generation of companies with proven space technologies. Now is the time for more traditional investors to identify clear revenue raising growth opportunities and scalable space technologies. The investment risk is less about the viability of new space technologies and more about the execution of scaling up and expanding. For institutional investors, it is now a question of capital allocation and portfolio exposure, or rather how big their appetite is to back the space industry when up against other sectors of the UK economy. Reflecting this inflection point, the private equity fund, NewSpace Capital, the first of its kind focusing on the growth stage of space enterprise, recently closed a funding round raising €100m.

Unresolved political risks

The UK has played a formative role in continental Europe’s space architecture as a founding member of the European Space Agency, the principal intergovernmental organisation that cultivates policies, develops programmes and administers funding for the space industry. Crucially, whilst independent from the European Union, it is inextricably linked in administrating the EU’s space and funding programmes. Despite the Brexit withdrawal agreement reached in January 2020, the EU continues to leverage UK participation and access to Horizon Europe, the €95.5 billion funding programme for research and innovation for 2021-2027, and Copernicus, the EU’s Earth Observation Programme, against the outstanding political issue of the Northern Ireland Protocol.

As stated by EU Commissioner Mariya Gabriel in October 2022, UK participation and access is ‘linked’ to (potentially conditional on) resolving the issue of the Northern Ireland Protocol. This political obstacle may be resolved by Rishi Sunak in 2023 as he adopts a more conciliatory approach when compared to his predecessors. For however long the uncertainty remains over the UK’s participation in Horizon Europe and Copernicus, it is damaging for both the UK and EU. Just as waiting in limbo risks the UK falling behind, there also exists a gaping hole in the EU’s planned investments without the UK’s contribution. This is particularly true given the US and China sizeably outspend the UK and EU as a percent of GDP. In the short-term, there are three possible outcomes:

Space falls within the remit of George Freeman, Minister for Science, Research and Innovation, and a former biomedical venture capitalist. In response to industry concerns about waiting in limbo, Freeman recently made available £200 million of the UK’s original £750 million commitment to Copernicus, demonstrating the Government’s willingness to be proactive in remedying some of the immediate bottleneck issues. In total, the Government committed £615 million to the European Space Agency, £217 million to global exploration programmes, £206 million to telecommunication, £111 million to space safety and security, and finally, £71 million to new technologies in November 2023. In addition, funding settlement increased in length from one to three years, a strategic decision for an industry that typically works toward longer timescales.

The House of Commons Science and Technology Committee has a less optimistic take on the UK’s position and approach to space. A recent inquiry found the Government wanting on several fronts and was critical of the Government’s sizeable stake in rescuing the once bankrupt company OneWeb, as well as its decision against developing a new sovereign sat-nav constellation. The Committee called for additional funding – perhaps to compete with that of China and the US – as well as for the Government to publish what a ‘Plan B’ might look like in the event that the UK is no longer granted participation and access to the EU’s space programmes.

Whilst the Government’s November funding announcement brings added certainty for the space industry, further increases in funding is highly unlikely given the cost-of-living crisis and pressure on the public finances. The mood music, however, is changing around the Northern Ireland Protocol with hopes of an imminent resolution, thereby enabling the combined heft of the UK and EU to collaborate on space. Nonetheless, the appetite for space technology will likely weather the UK’s economic recession and with a maturing space market, private investment will be mission critical to ensuring an economic lift off for the next trillion dollar industry.

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UK and Japan – The Quiet Relationship

An island nation, obsessed by tea, known for the politeness of its people and with a hereditary sovereign as head of state. Add the sight of cars driving on the left, school children in uniforms and pubs in every town and there is only country in the world that you could possibly be thinking of.

You would think.

In fact, there are two countries you could be thinking of. The UK or Japan. The island monarchies share similar drinking habits and traffic quirks as well as a long history and a significant economic relationship.

Not that you would know it from reading the news. Missives from political correspondents in Washington D.C. and spats between the UK and France provide much more saleable copy. But that is no reason to ignore the fruitful relationship between East and West. Ever since Margaret Thatcher’s visit to Japan in 1982, the UK and Japan have enjoyed a quiet, steady-as-she-goes relationship that is both strong and stable (to coin a phrase).

If the relationship lacks the drama of the UK’s bonds with its European or North American friends, it shouldn’t be overlooked as a place for low-risk growth opportunities and expansion.

Let’s look at the numbers.

The total value of trade between the UK and Japan to the end of June 2022 stood at £24.6 billion, an increase of nearly 22% since 2012. Total trade before the Covid-19 pandemic was admittedly higher than it is today, reaching £28.8 billion in 2019, but this is par for the course. Total trade grew by 0.6% between 2021 and 2022. The green shoots of recovery are there.

Foreign Direct Investment tells an even better story. Between the vote to leave the EU in 2016 and the Covid-19 pandemic in 2020, investment into the UK from Japan more than doubled from £45.5 billion to £102.3 billion. Over the decade since 2011, inward investment to the UK from Japan has grown nearly fourfold. The decrease in the value of sterling against the yen has, of course, been a major contributory factor. The fall in the pound from just over ¥195 in August 2015 to a low of ¥125 in March 2020 has made investment in the UK significantly more attractive.

But there are other reasons to be optimistic about the opportunities the relationship creates. The UK-Japan Comprehensive Economic Partnership Agreement, signed in October 2020, was the first trade agreement the UK signed outside of the EU with any country. It provided an important political signal of intent between London and Tokyo: that practical economic considerations would win out over any political posturing following the UK’s exit from the EU.

Japan’s enthusiasm for the UK’s application to join the Comprehensive and Progressive Trans-Pacific Partnership (CPTPP) is a further sign of the value that Tokyo places on London’s contribution to international trade and politics in the East. Japan’s Economy Minister, Yasutoshi Nishimura, said that “the importance of Britain as a strategic partner and the expansion of the high-level rules beyond the Asia-Pacific are extremely important.”

Since 2018, British troops have also participated in training exercises in Japan with the Japanese Ground Self-Defence Forces through the VIGILANT ISLES series. In May 2022, then Prime Minister Boris Johnson and Prime Minister Fumio Kishida agreed a Reciprocal Access Agreement to facilitate UK and Japanese Armed Forces on training, joint exercises and disaster relief activities – the first such agreement for a European country with Japan. Johnson also announced the appointment of a new trade envoy to Japan, former Business Secretary, Greg Clark MP, to drive investment between the two countries.

Emperor Naruhito and Empress Masako’s attendance at The Queen’s funeral in September was the couple’s first overseas trip since the emperor’s accession in 2019. A further diplomatic coup and a show of the enduring relationship between the royal families.

Relations between the two countries are arguably stronger now on the economic, military and diplomatic front than at any time since the Meiji restoration in 1868. The ever-closer relationship between London and Tokyo puts the stability of Japanese investment in the UK in good stead over the medium to long term. For investors, the opportunities that stem from this relationship should not be ignored – even if they don’t make the headlines.

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UK and China – Happily Never After?

The UK and China were once good friends. Or so we were led to believe. Speaking at the Shanghai Stock Exchange in September 2015, then Chancellor of the Exchequer, George Osborne, spoke about creating a ‘golden age’ in Sino-British relations.

A month later, President Ji Xinping paid a state visit to Britain which included a ride down The Mall with The Queen and a lavish banquet in his honour at Buckingham Palace. Ensconced between The Queen and the Duchess of Cambridge at the banquet, President Xi could justifiably feel that his country had found its bestie in the West.

In 2018, the Chinese Ambassador to London talked about turbocharging relations even further. He wanted to put the golden age into “higher gear”, he claimed, and build “an even brighter future for the people of our two countries”.

It all seemed so rosy and the future for investors looked so promising.

But fast forward to 2022 and the geo-political landscape is unrecognisable. The Golden Age has turned into an Ice Age – a period of recriminations, grievances and conversations labelled ‘frank’ in diplomatic circles. Investors would be right to be wary.

Demonstrations in Hong Kong, concerns over Huawei’s proposed investment in strategic infrastructure, human rights abuses in Xinjiang, the Covid-19 pandemic, and scenes of the Chinese police beating a BBC journalist are hardly propitious foundations for friendship. President Xi, who has secured an unprecedented third term as leader, has also doubled down on an assertive foreign policy. He rails against so-called Western ‘bullying’ and is pushing a repressive domestic agenda intent on eradicating Covid-19. The two governments now view each other with grave mistrust, with Prime Minister Rishi Sunak stating that the “golden era is over, along with the naïve idea that trade would automatically lead to social and political reform.”

The politics, in short, bode badly for the future. The economics, however, tell a different tale.

Trade volumes between the UK and China have increased by 27% over the last four years. Total trade in 2018 stood at £73.2 billion, rising to £86.8 billion in 2019 before falling during the pandemic and rising again to £93.1 billion in 2021.

Maybe that’s because the UK and China can’t afford to let political fights upset their economic relationship. The downturn in the UK economy is well documented. GDP growth fell 0.3% between July and August and the UK economy is smaller now than at the start of the year. Former Prime Minister Liz Truss’ efforts to turn the tide were met with widespread disruption in the financial markets, with the Bank of England stepping in to support the bond markets, and mortgage interest rates rising to their highest level in 14 years. It’s also a difficult time for private markets: the UK economy is officially in recession.

If things are bad in the UK, prospects in China are not much better.

The Chinese economy used to be the thing of myth, with growth that made Western leaders salivate at the prospect of getting a slice of the pie. Annual growth in the Middle Kingdom saw a clear upward trajectory in the late 1990s and early 2000s, reaching a peak of 14.2% in 2007. But ever since, the Chinese economy has been distinctly less appealing. China has recorded a steady decline in annual GDP growth since 2007, falling to 6% in 2019 and temporarily plunging to 2.2% in 2020 – the pandemic year. While growth of 6% in 2019 (and over 8% in 2021) may still sound tempting to some Western leaders, there is more trouble looming.

This year, the yuan fell to its lowest rate since 2008 and the national youth jobless rate hit almost 20% in July. Even official statistics shows that China’s manufacturing PMI has only been above 50% for four months of 2022 – any figure below 50% shows a reduction in activity – with manufacturing PMI in October standing at 49.2%. JP Morgan also forecasts year-on-year GDP growth in the final quarter of the year to stand at 2.7%, down from a previous forecast of 3.4%.

The property market in China is in turmoil too. Year-on-year, property sales fell by over 23% in October and property investment has declined by 16%. In August, house prices fell by 1.3% – their fastest decline in seven years. Chinese policymakers have attempted to sweeten the market by cutting the five-year loan prime rate that underpins mortgage lending to 4.3% and relaxing the floor on mortgage rates for some first-time buyers. But the bitter taste of an undercooked pie still lingers. The property crisis took a trillion dollars off the value of the sector last year.

But investors should steady their nerve. As their economies stutter at home, the UK and China need to keep in with their economic partners overseas. The Prime Minister may continue to view China as a “systemic challenge to our values and interests” but he also claims that we “cannot simply ignore China’s significance in world affairs”. Significant material restrictions in trade have yet to materialise, despite tensions between London and Beijing. Economic reality, it seems, trumps political posturing. UK firms exposed to Chinese investment will be able to rely on firm support from their Asian trading partner for the foreseeable future and trade between the UK and China will continue to boom. Even if President Xi won’t be enjoying another carriage ride down The Mall anytime soon.

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